Audit and Practice Survey Posters 286 – 302
286 How to optimise asthma management through patient centred care in general practice
Aims: To discuss whether patients who have been given a diagnosis of asthma are regularly followed up and given an updated personalised management plan based on their symptoms.
Content: The poster combines data from an audit conducted at a general practice in Manchester, which included patients aged 18-25 years who have an active diagnosis of asthma. We looked at retrospective data of these patients receiving reminders of their annual asthma review. This led to a discussion into the importance of asthma reviews and subsequent management, which should be updated, based on patient’s current severity. The audit also highlighted the necessity of specifying smoking status and the substance smoked by patients, as some patients may not smoke tobacco however smoke cannabis which can affect their asthma status. This audit has suggested that more guidance and personalised managements can be provided to these patients, and in order to achieve that more specific questions can be developed to collect data.
Relevance: As there is an increase of individuals living with asthma, delivering patient centred management including advice and updating data frequently has become more essential. Targeting these patients regularly can in effect improve their quality of life.
Outcomes: 6 out of 10 patients that were included in the audit did not receive their annual asthma review last year; as a consequence their details were not updated.
Discussion: The results highlighted the importance of regular management of patients with a diagnosis of asthma, and the need of regularly updating their details. Clinicians could potentially use a set few questions that can be asked to the patients during their review, which would lead to accurate update of their relevant details.
287 Audit: Investigating the rates of flu vaccine uptake amongst children aged 2-4 years in a primary care setting during the 2015-2016 flu season
Background: Global studies have indicated that children are the engines of influenza outbreaks as they are the main transmitters of the virus. Therefore, the national immunisation programme has been extended to include children aged 2-4 years. Vaccinating such groups can induce herd immunity and relieve the socioeconomic burden associated with the flu. The live, attenuated influenza vaccine (LAIV) is licensed for child immunisation and has shown to be effective and well tolerated due to its various benefits including the nasal administration.
Aims: To assess whether 60% or more of children aged 2-4 were vaccinated using the LAIV during the 2015-2016 flu season, based on national guidelines and standards.To explore the potential barriers and drivers to vaccination.Method: The Egton Medical Information Systems (EMIS) was used to collect data. The dates of birth were customised to document children born on/after September 31, 2010 and on/before August 31, 2013. 204 children were found to meet the criteria.
Results: Out of 204, 98 children were vaccinated, revealing a total percentage of 48% of registered children who had been vaccinated, dissatisfying the audit’s standard (60%). The main vaccination barrier was the low perceived risk of flu, while drivers included the vaccine’s nasal administration.
Conclusion and proposals: Children are affected by the flu the most annually, therefore offering the vaccine to 100% of entitled individuals is key. To improve uptake, proposals included:Patient education regarding the benefits of immunisation.Recording parent contact details to relay vaccine reminders.Recording vaccine refusal reasons to explore concerns.
288 The creation of a new island medical team and a reduction in air transfers to mainland hospitals – audit of air transfers over 4 years from a rural community
AIMS/OBJECTIVES: To compare the record of air transfers over 4 years to see if they reduced under a new team of GPs CONTENT Reflects data collected using local “Air Audit Forms”. Started by our predecessors these record the date and reason for transfer, age/sex of the patient and involvement of the Retrieval Team.
RELEVANCE/IMPACT General practice is changing – both in rural and urban areas. Smaller populations in rural practice can allow quick changes to care provision. Rural recruitment is difficult yet locally from mid-2014 to April-2015 we recruited 4 GPs under the age of 40 with an array of interests (anaesthetics, orthopaedics, cardiology, psychiatry). The three Practices have moved to working under a single umbrella practice model. Improved teaching in the hospital allows us to utilise more of the nurses’ skills reducing the number of transfers.
OUTCOMES The data reflects a decrease in the number of transfers over the 4 years (see poster below)
DISCUSSION Certain areas – obstetrics, gynaecology, paediatrics and trauma have remained static. Cardiac, medical and particularly orthopaedic transfers have dropped. This may be multifactorial eg increased access to bedside testing. Overall the trend does appear to be downwards. We hope this can be extrapolated further – both in the rural, but also in the urban environment.
300 Role of GPs in transition
The aim was to find out how engaged were GPs with transition of care from paediatrics to adults. We surveyed GPs across the region via survey monkey and asked 5 key questions: Is transition important? Does primary care have an important role in transition? Are you as a GP involved appropriately? Do you have a young persons lead who could lead on transition in your practice? If no practice lead, do you see the benefit of having one?
We received 55 responses.The summary was: Majority of GPs felt transition was important. Less than half GPs felt appropriately involved with transition. Majority of GPs did not have a transition lead but saw the benefit of having one. We incorporated this in to the regional transition toolkit and this has been sent to CCGs. The survey highlights the importance of GPs in transition and the need to engage with GPs during transition as GPs have been at times sidelined during the process of transition.
301 Do patients presenting with lower limb fractures to general practice have a FRAX score measured to rightfully intervene with a DEXA scan or medical therapy?
Background: Recent studies have shown a dramatic rise of patients presenting with fractures in the UK. This could be due to increased life expectancy as well as the improper risk assessment of patients most likely to suffer from osteoporosis. A fracture risk assessment tool (FRAX) calculates the probability of a major fracture within the upcoming 10 years.
Aims: To explore whether FRAX was used in primary care and if so, how effective it was as a method of investigation.
Method: NICE guidance on the implementation of the FRAX tool was published in 2012. As a result, a cohort of patients presenting at the practice with a fracture four years ago was investigated over a 12 month period; fractures of lower limb and ages 40 to 90 were the prerequisite. There were 31 such patients identified and a FRAX score was determined. The standard set was 100% patients would have a FRAX score estimated to assess the necessity of a DEXA scan.
Results: Out of 31 patients, only one had a FRAX score calculated and 23 should have had a DEXA scan referral. This indicated the need for using FRAX in healthcare settings to minimise the risks associated.
Conclusion and proposals: Fractures are becoming more common and can result in serious complications due to increasing age; investigating them at the time of presentation can save the NHS substantial time and money. Recommendations include appointing clinical leads in practices who receives all fracture referrals and calculates the FRAX score to act accordingly.
302 Implementation of the updated NICE guidelines on the cardiovascular risk assessment and use of statins in current psychiatric inpatients: a local audit
Awangku Ahmad Syukri Pengiran Hj Abdul Rahim
Background The link between severe mental illness and cardiovascular disease has long been established. Lipid profile is usually done as part of the ‘’routine’’ blood tests on admission. Statins appears to be under-utilised.
Aim: 1 To estimate the 10-year cardiovascular risk using QRISK2 for eligible patients at the Harbour (an acute psychiatric unit). 2 To identify those who are at >10%risk of developing cardiovascular event over the next 10 years. 3 To assess the implementation of current NICE guideline on lipid modification. 4 To compare the level of cholesterols in patients who are and not on statins
Method All in-patients (mid-end October) on 6 wards at the Harbour were included. SPSS v20 was used. Multiple linear regression was used to adjust the effect of age, gender and BMI on cholesterol level.
Results 77 patients were included. Baseline lipid profiles were done in 61 patients (79.2%) on admission. However, full lipid profiles were only done in 50 patients. 49 patients were found to have >10-year CV-risk, out of which, only 30.4% were on statins. Interestingly, ALL WERE PRESCRIBED PRIOR TO ADMISSION – NO interventions were made as inpatient. Most importantly, there also appeared to be little or no communication between primary and secondary care interface to improve these.
Conclusion Whilst there appeared to be some compliance with getting ‘’baseline’’ lipid profiles on admission, no interventions appeared to be done subsequently. It was evident from the current sample that those who were on statins had statistically significant lower level of cholesterol level than those who were not statin, even after adjusting the effect of age, gender and BMI. Most importantly, should acute psychiatric team be taking more responsibility?