CLINICAL INDICATORS

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CLINICAL INDICATORS and QUALITY in
PRIMARY CARE
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PRIMARY CARE IS LED BY GENERAL PRACTITIONERS
General Practice Practitioners Nurses WTE
per 100,000 patients 70 24 Share of clinical
encounters 72 27 PTI data, 37
practices
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THE MYSTERY OF PRIMARY CARE
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PRIMARY CARE SECONDARY CARE Scattered Concen
trated Horizontal Vertical Self-employed Sal
aried Generalists Specialists
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MAXIMUM ORGANISATIONAL QOF POINTS BY
DEPRIVATION DECILE IN SCOTLAND

 
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MAXIMUM CLINICAL QOF POINTS BY DEPRIVATION
DECILE IN SCOTLAND

 
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MAXIMUM CLINICAL QOF POINTS BY DEPRIVATION
DECILE IN SCOTLAND

 
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(No Transcript)
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STRIKING THE RIGHT LEVEL The clinical
encounter The practice The Community Health
Partnership NHS Scotland
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4 KEY ELEMENTS OF PRIMARY CARE First
contact Continuity Comprehensiveness Co-ordinat
ion STARFIELD
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PRIMARY CARE MAKES A DIFFERENCE Does health
care improve health? Craig, Wright, Hanlon and
Galbraith Journal of Health Services Research and
Policy 2006111-2 Medicine matters after
all Bunker Nuffield Trust, 2001 Does health care
save lives? Avoidable mortality revisited Nolte
and McKee Nuffield Trust, 2004
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MAKING A DIFFERENCE IN PRIMARY CARE Reducing
severity symptomatic treatment Delaying
progression Mx long term conditions Reversing
risks BP, cholesterol, smoking Secondary
prevention cervical screening Primary
prevention diet, exercise Health protection -
immunisation
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KEY ELEMENTS Effective interventions
Population approach Long term
relationships
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ILL-HEALTH VARIABLES BY DECILE
 
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GP Resources by Deprivation Decile

 
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GENERAL PRACTICES IN SCOTLAND BY DECILE OF
DEPRIVATION Decile Population No of No of
GPs(WTE) practices 1
Affluent 535290 344 94 2 537391 378 112
3 534250 363 114 4 539389 364 95 5 5
29883 355 97 6 535521 355 108 7 536082
352 93 8 535599 339 105 9 538462 332
105 10 Deprived 528283 352 124 Briti
sh Medical Journal 20053311449-51
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DEPRIVATION, PSYCHOLOGICAL DISTRESS
AND CONSULTATION LENGTH IN GENERAL
PRACTICE Mark Stirling, Phil Wilson, Alex
McConnachie British Journal of General
Practice 200151456-60
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ANALYSIS OF 1000 CONSULTATIONS IN GENERAL
PRACTICE DEPRIVATION MEAN PREVALENCE CATEGORY
CONSULTATION OF POSITIVE TIME GHQ
(4) minutes 1 9.5 33 2 10.3
43 3 8.1 40 4 7.9 40 5 8.1 4
0 6 8.7 46 7 8.4 60
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GENERAL PRACTICE IN DEPRIVED AREAS
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Voluntary activity in practices
PRACTICE ACCREDITATION
SPICE

TRAINING
PMS
 
British Medical Journal 20053311449-51
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LOCATION OF THE MOST DEPRIVED PRACTICES IN
SCOTLAND HEALTH Decile 10 Decile 9 OF
ALL BOARD PRACTICES Greater
Glasgow 111 31 65 Lanarkshire 3 35 38 Ayrshi
re Arran 3 8 18 Argyll Clyde 4 12 16 Tay
side 5 6 15 Fife 1 6 12 Lothian 6 5 8
Forth Valley 0 3 5 Borders 0 0 0 Grampian
0 0 0 Dumfries and Galloway 0 0 0 Highland 0
0 0 Western Isles 0 0 0 Orkney 0 0 0 She
tland 0 0 0 TOTAL 133 106 100
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DEPRIVATION IN FOUR GENERAL PRACTICES PRACTICE QU
INTILE OF SOCIO-ECONOMIC DEPRIVATION Q1 Q2 Q3
Q4 Q5 1. 0.8 1.2 1.9 2.5 93.6 2. 22.6
18.4 20.3 19.8 18.8 3. 63.6 1.8 6.1 12.
4 16.0 4. 74.5 25.2 0.0 0.0 0.0 S
ource - SPICE
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GENERAL PRACTICES IN SCOTLAND BY DECILE OF
DEPRIVATION Decile Population No of No of
GPs(WTE) practices 1
Affluent 535290 344 94 2 537391 378 112
3 534250 363 114 4 539389 364 95 5 5
29883 355 97 6 535521 355 108 7 536082
352 93 8 535599 339 105 9 538462 332
105 10 Deprived 528283 352 124 Briti
sh Medical Journal 20053311449-51
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• CHD PREVALENCE IN PRACTICE POPULATIONS
• UNDER 70 IN NHS GREATER GLASGOW
• CHD EMAs Angina No of Population
• deaths practices
• 1 Most deprived 9.1 46.2 6.7 24 82,502
• 2 10.7 40.8 6.4 26 81.927
• 3 8.3 34.6 5.9 20 82,163
• 4 8.0 34.0 5.6 20 90,407
• 5 8.7 27.5 5.0 27 79,680
• 6 6.2 22.2 4.5 20 82,795
• 7 6.7 21.7 4.2 21 84,456
• 8 4.9 18.6 3.7 21 84,922
• 9 2.9 15.3 3.0 13 89,007
• Most affluent 2.7 14.8 2.8 17 81,941
• 101 Ratio 3.3 3.1 2.4

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• TRENDS IN STATIN PRESCRIBING IN PRACTICE
  POPULATIONS
• IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5
• Dispensed daily doses (millions)
• 2001/2 2004/5 Increased
• 10 Most deprived 1.08 5.74 5.31
• 9 1.10 5.93 5.39
• 8 0.96 5.39 5.61
• 7 0.92 4.86 5.28
• 6 0.90 4.74 5.27
• 5 0.87 5.30 6.09
• 4 0.98 5.05 5.15
• 3 1.00 4.70 4.70
• 2 0.86 3.55 4.13
• 1 Most affluent 1.04 4.63 4.45
• 101 Ratio 1.04 1.24

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• TRENDS IN STATIN PRESCRIBING IN PRACTICE
  POPULATIONS
• IN NHS GREATER GLASGOW BETWEEN 2001/2 AND 2004/5
• Total prescriptions (millions)
• 2001/2 2004/5 Increased
• 10 Most deprived 0.024 0.07 2.91
• 9 0.025 0.07 2.80
• 8 0.020 0.06 3.00
• 7 0.018 0.06 3.33
• 6 0.017 0.05 2.94
• 5 0.018 0.06 3.33
• 4 0.018 0.06 3.33
• 3 0.019 0.05 2.63
• 2 0.017 0.04 2.35
• 1 Most affluent 0.018 0.05 2.77
• 101 Ratio 1.33 1.40

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• MEASURES OF CHD PREVALENCE IN PEOPLE UNDER 70
• Decile CHD deaths CHD Prevalence Prevalence
• under 70 EMAs of Rose angina of CHD in
• per 10,000 per 10,000 per 10,000 the QOF
• population population population (all ages)
• 1 3.3 13.8 255 312
• 2 4.6 23.0 287 356
• 4.5 20.5 298 359
• 4 5.1 24.6 298 359
• 5 6.3 24.9 345 385
• 6 5.4 29.7 340 404
• 7 6.8 30.4 387 406
• 8 7.6 34.0 399 414
• 9 7.9 35.4 427 419
• 10 8.9 38.3 570 423
• 10/1 2.7 2.8 2.2 1.4

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• PREVALENCE OF GLASGOW PATIENTS WITH ANGINA
• BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
  DEPRIVATION
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 13 26 38 23
• 18 28 35 19
• 3. 19 28 35 18
• 4. 22 31 33 14
• Most deprived 23 29 33 15
• Row percentages

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• DISTRIBUTION OF GLASGOW PATIENTS WITH ANGINA
• BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
  GROUPS
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 11 15 18 21
• 2. 15 16 17 19
• 3. 20 20 21 22
• 4. 25 23 20 17
• Most deprived 29 26 24 21
• Column percentages

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• PREVALENCE OF GLASGOW PATIENTS SURVIVING MI
• BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
  DEPRIVATION
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 14 26 36 24
• 21 27 33 18
• 3. 22 26 33 18
• 4. 25 28 32 15
• Most deprived 22 27 34 16

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• DISTRIBUTION OF GLASGOW PATIENTS SURVIVING MI
• BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
  GROUPS
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 11 16 18 22
• 2. 18 18 18 19
• 3. 22 21 21 22
• 4. 24 21 20 17
• Most deprived 24 23 23 20
• Column percentages

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• PREVALENCE OF GLASGOW PATIENTS WITH HEART FAILURE
  
• BY AGE WITHIN QUINTILES OF SOCIO-ECONOMIC
  DEPRIVATION
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 7 20 37 26
• 2. 12 24 38 26
• 3. 13 23 37 26
• 4. 15 25 38 21
• Most deprived 14 25 39 22

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• DISTRIBUTION OF GLASGOW PATIENTS WITH HEART
  FAILURE
• BY QUINTILES OF DEPRIVATION WITHIN 10 YEAR AGE
  GROUPS
• Quintile Age
• lt60 60-69 70-79 80-89
• Least deprived 8 12 14 20
• 2. 16 17 17 17
• 3. 22 21 21 22
• 4. 26 23 22 18
• Most deprived 29 27 26 22
• Column percentages

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Comparing OBSERVED with EXPECTED
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MEASURING WHAT IS ..
NOT WHAT SHOULD BE
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(No Transcript)
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THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ANGIOGRAPHIES PER CAPITA, 45-74
 
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EXPECTED ANGINA PREVALENCE BY PRACTICE, AGAINST
DEPRIVATION
 
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THE EFFECT OF USING PREVALENCE-BASED DENOMINATORS
ON FINDINGS
ANGIOGRAPHIES PER CAPITA, 45-74
ANGIOGRAPHIES PER EXPECTED CASE
 
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CO-MORBIDITY The number, severity and
complexity of health and social problems within
families
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• CONCENTRATIONS OF
• Problems within families
• Families within practices
• Practices within areas

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What do clinical indicators mean for The
clinical encounter ? The practice ? The
Community Health Partnership ? NHS Scotland ?
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What can do done at the level of The clinical
encounter The practice The Community Health
Partnership NHS Scotland to improve clinical
indicators ?