Developing High Risk registers in Primary Care

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Developing High Risk registers in Primary Care

• Candy Jeffries
• Beds and Herts Cardiac Network

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Why have a high risk register?

• Deep down, we all know it makes for good clinical
  practice.

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Standard 4 of the NSF for CHD states

• General practitioners and primary health care
  teams should identify all people at significant
  risk of cardiovascular disease but who have not
  yet developed symptoms and offer them appropriate
  advice and treatment to reduce their risks.

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And continues

• Practices should put in place models of care so
  that they
• Use a systematic approach for
•       Identifying people at high risk of CHD
•       Identifying and recording modifiable risk
  factors of people at high risk of CHD
• Providing and documenting the delivery of
  appropriate advice and treatment and offering
  regular review to people at high risk of CHD.

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Problems, problems..

• CHD versus CVD
• High risk and moderate risk
• What tools
• Commercial software
• Work, work and more work?
• Payment
• Untreated BP/cholesterol levels
• What about patients already on statins..--

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Quick tips for getting started

• Search for patients on statins, without a CHD/CVD
  code.
• (All familial hyperlipidaemics should be on
  statins and therefore in this group.)
• Some of these may be on statins but not high
  risk.
• Make the decision to either take them off
  statins, or treat them as high risk.
• This is your current high risk register-code it

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And then.

• Call in at risk groups, or label/tag them for
  assessment and see them at their next
  medication/chronic disease review to risk assess.

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Who is at risk?In descending order (ish)

• Diabetics (? All except children/young women at
  risk? Or use UKPDS tool)
• Hypertensives
• Smokers
• Obese
• FH
• Ethnic Groups
• Socially deprived
• Impaired glucose metabolism
• Borderline hypertensives
• Men over 40 (over 30 in S Asian risk groups)

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Risk assessment tools

• Framingham
• Sheffield
• New Zealand
• JBS
• BHS
• Assign
• QRISK
• Whatever

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What next?

• How can we help?
• How to documents
• Education
• Training
• Practice visits
• Physical assistance
• You tell us.