Audit and Practice Survey Posters 242 – 247
242 Audit of patients diagnosed with cancer following and emergency presentation
Audit of patients diagnosed with cancer following an emergency presentation Aim: The project aim was to identify and understand common themes for late diagnosis of cancer in patients diagnosed following an emergency presentation and agree recommended improvement actions.
Content of Presentation: A thematic map of the causal mechanisms identified by the audit that contributed to why a patient presented as an emergency. The underlying factors which led to why cancer was not diagnosed earlier could be grouped into three broad areas; tumour, person and system /health care professional.
Relevance /Impact: Between one in four and one in five people in England with cancer are diagnosed as a result of an emergency presentation (EP). Analysing over 160 Significant Event Audits this audit’s findings from more than 70 GP practices provides in-depth insight and understanding in to this challenging part of the pathway.
Outcomes: The underlying factors which led to why cancer was not diagnosed earlier could be grouped into three broad areas; tumour, person and / or system (including primary and secondary care). Learning points put forward by the GP practices could be amalgamated into several themes including events during the primary care consultation, processes in primary care, the interface with secondary care, and issues with investigations.
Discussion: Factors determining why some patients are diagnosed through an emergency route are complex and although there is no silver bullet that will reduce these numbers, it is possible that a small degree of change across all the causal mechanisms will result in earlier diagnosis and contribute to a less traumatic experience for the patient and their family.
243 An audit of cancer referral and diagnosis in general practice
Objective: To evaluate the diagnosis of cancer in a medium sized, suburban GP surgery in comparison to national averages and standards.
Relevance: Cancer is the disease with the highest mortality amongst all age groups in the UK and has an overall incidence which is on the rise. Detecting cancer earlier can lead to better outcomes for patients. Therefore it is vital that GPs are appropriately assessing and referring patients with potential cancer, and that any factors which could delay a patient’s diagnosis are identified and dealt with accordingly.
Content: The health records of all the patients at this practice diagnosed with a qualifying cancer between April 2014 and March 2015 (n=37) were examined and the information used to populate the RCGP National Cancer Diagnosis Audit Tool. The circumstances surrounding their diagnosis were analysed and compared to national data.
Outcome: 59% of cancers were diagnosed as a result of a two week wait referral and 11% after an emergency presentation, compared to the national averages of 25% and 24% respectively. The average time between first primary care attendance and referral was 21 days.
Discussion: The practice was found to be maintaining high standards in cancer diagnosis, adhering to NICE guidelines and referring patients in a timely manner. This resulted in a better performance than the national average in certain measures of cancer diagnosis. Findings were discussed with the practice GPs who have considered improving suspected cancer referrals further by implementing enhanced measures for dealing with abnormal blood results and safety-netting.
244 What internet sources do patients use to find health-related information?
Aims To discover which internet sites patients use to find health information and the effect on emotional wellbeing.Objectives To identify online sources used by patients for health information. To determine whether patients felt more or less informed about health or worried after Internet use.
Method Survey at a 5 partner practice of 10000 patients in Cornwall. 141 patients were asked about Internet use to search for symptoms before consulting their GP and about their subsequent feelings. Data entered into Excel for descriptive statistical analysis.
Results 55/141 patients used Internet searching for symptoms. 42/55 patients (76.3%) used NHS Choices. 23/55 patients (41.8%) said they were more informed after Internet use. No patients felt less informed. 24/55 patients (43.6%) experienced no changes to worries, 8 were less worried (14.5%), 4 were more worried (7.27%).
Discussion Most patients felt more informed after using the Internet to search for symptoms. NHS Choices was the website most frequently used. Most reported searching online had no impact on their worries.Our study is one of the first in UK general practice. Weaknesses include sample size and the sample may not be representative of the UK population.It has been reported that Internet use may cause “cyberchondria” in a study where 38.5% of patients were more anxious about health after using the Internet, but 50.3% were less anxious. Our results differ, possibly due to patient demographics. Further research including surveys using larger sample sizes may give more representative data and establish how each website affects patients’ anxiety.
245 Investigation and management of uncomplicated urinary tract infections
Aims: This work contributes to the growing interest and developing body of literature exploring inappropriate antibiotic prescription and its role in escalating antibiotic resistance.
Relevance: The study aimed to evaluate investigative tools used by clinicians in the community for patients presenting with lower urinary tract symptoms and to assess the antibiotic uses in these patients, with reference to Local CCG Guidelines.
Content: Female patients aged 16 and above coded as having ‘uncomplicated UTI’ at a GP Practice from September 2015 to January 2016 were selected from the EMIS system. There were 65 patients found. The management documented within these consultation notes, were compared against local guidelines, taking into account the antibiotic prescribed and the investigative tools used.
Outcomes: Clinicians adhered to guidelines on 49%(32/65) of the coded encounters. Local protocol was not adhered to in 45%(29/65) of consultations and in 6%(4/65) of patients there was not enough notes recorded to decide. Reasons for non-adherence to the guidelines included prescribing an incorrect course of treatment, 52%(15/29), and an inappropriate antibiotic being prescribed, 28%(8/29).
Discussion: Results identified guidelines were not adequately met based on an 80% standard set by an RCGP audit template. Recommendations in this report suggest changes in the EMIS system, developing a strict policy of prescribing during telephone consultations, emphasising the importance of antibiotic resistance during lunchtime audit meetings and finally for clinicians to use the Target UTI Audit template to audit their own prescribing.
246 “A healthy mind has an easy breath” – an audit of converting adult asthma patients from Seretide (and generics) to Sirdupla in general practice
Aim The aim of this audit was to review adult asthma patients with Seretide 250 and 125 inhalers on repeat prescription with the aim of reducing the prescribing of Seretide MDI inhalers in favour of switching to the more cost effective brand Sirdupla.
Contents/relevance We are a six-partner Nottinghamshire training practice with approximately 15,000 patients. We have a higher than average number of patients with respiratory disease due to being located in a former coal mining area and having a high prevalence of patients who smoke. Regular inhaled corticosteroids are the first-choice preventer therapy for adults and children with asthma for achieving overall treatment goals. A search was performed identifying all eligible patients. Once the data was extracted the data was reviewed with the primary care pharmacist. Patients were then be switched.
Outcome There were a total of 64 asthmatic patients who were on Seretide MDI and 52 who were on generic Fluticasone/Salmeterol MDI (not prescribed as Sirdulpa). The 64 patients who were on Seretide MDI were converted onto Sirdupla. The audit searches were re-run over a year later and 64 asthmatic patients remain on Sirdulpla.
Discussion The recommendations for change in practice were implemented between the first and second audit cycles. The change has remained and the audit loop has been successfully closed. The conversion of our Seretide patients onto Sirdupla equates to an approximate annual cost saving for our practice of £10,700. If rolled out across all general practices in England, it would equate to a significant cost saving for the NHS.
247 Assessing the incidence of a level 3 medication reviews within a year in patients with diabetes mellitus
Introduction The General Medical Service (GMS) and NICE guidelines advice that medication reviews should be done in a systematic way, placing emphasis on those with chronic conditions and polypharmacy who need regular reviews. The GMS advises that reviews should be performed to at least a level 2; NICE indicates that patient centred approach should be taken, which corresponds to level 3 medication review (although no level of review is indicated in the guidelines). Focused on level 3; clinical medication review, face to face review of medicines and conditions
AimAssessing whether type 1/2 diabetic patients have had a medication review at level 3 in the last 12 months, keeping with GMS adivce as well as NICE guidelines. The standard was set at 80%, which is in keeping with Quality Outcomes Framework, but also considers issues such as compliance and non attendance.
Relevance Clinical medication reviews help identify any issues with patient problems; but also each medication is considered in the context of the patients’s condition; the impact of the medications on the way patients live their life is also considered. Clinical and pyschosocial approach to med review (level 3).
Outcome Data from 161 diabetic patients was collected (random). 80 had a medication review within 12 months and 81 hadn’t, 49.7% (80% standard). Out of those who had not, 49 patients were on 6 or more medication. NB 2nd Data collection in September 16, BEFORE conference.
Discussion Systematic checks by admin staff on diabetic patients, who will then send notifications to doctors that a medication review is needed. More awarness by doctors, especially when approving repeat prescriptions for diabetic patients, that medication review has been done recently.