Audit and Practice Survey Posters 310 – 313
310 Patterns of health care use of frequent attenders at very deprived general practices in Glasgow
Aims: Govan Social and Health Integration Partnership (SHIP) started on 1st April 2015, at 4 general practices which serve the 16th, 28th, 30th and 32nd most deprived Scottish populations.The study aims were to: 1) Describe the health care contacts, in one year, of a representative sample of patients who are frequent users of health care at the practices; 2) Describe the allocation of SHIP interventions to them; 3) Assess potential impacts of SHIP interventions on health care use.
Methods: 400 patient’s data were collected from EMIS and Docman.
Results: GP consultations were fewer in 2015 than in 2014.40% of patients were aged 45-64 and 66% were female. Over 50% of patients were taking antidepressants.72% of health care contacts were in primary care (85% with the GP), 19% secondary care and 9% unscheduled care. 50 sample patients received a SHIP intervention. 6 patients had 54% of SHIP OOH, NHS 24 and A&E care and 4 patients had 66% of emergency admissions. 19 patients had no unscheduled care, 10 of whom had been discussed at MDTs. Patients who had extended consultations had less unscheduled care contacts than other SHIP patients.
Conclusions: “Frequent attenders” is not a stable definition. A small percent of “frequent attenders” were in SHIP, suggesting that this is not the main inclusion criterion. A small number of SHIP patients accounted for a large unscheduled care workload, which needs evaluation to see if it was being used instead of primary care. Targeted SHIP interventions have the potential to decrease unscheduled care and task shift the GPs workload.
311 Retrospective review of cardiovascular risk prevention in primary care before and after a stroke
Objectives: An audit was conducted to assess the provision of preventive activities in primary care both before and after a stroke event, and to find possible explanation for variation.
Content: 8 local practices in a deprived part of London participated. Primary care records (N= 197) of all patients who had a stroke between January 2009 and December 2012 were selected. Two GPs reviewed the clinical entries for cardiovascular prevention activities covering the periods 6 months before and 6 months after each event of stroke. Due to missing data, only 123 cases were included. Notes were summarised for the audit. Further analysis was performed using simple statistical techniques to determine the variation in the preventive activities by patient characteristics.
Relevance: Mean age is 73.4 years (range 21 to 101). 85% (104/123) have one or more co-morbidities.
Outcomes: Before stroke events, 49% had no record of smoking cessation offer, 61% no record of CVD risk assessment, 41% annual lipids uncontrolled, 41% no influenza immunisation and 60% HbA1c not tested. After events, the smoking cessation and flu immunisation offer did not improve; but HbA1c and lipid control improved (+27% and +24% respectively). There is no systematic variation in the way interventions were offered by age, gender, or ethnicity. Nonetheless, HbA1c test, influenza immunisation, medication review and smoking cessation offer showed correlation with living arrangement.
Discussion: Cardiovascular risks can be better managed in patients with a relevant comorbidity. Further reviews may benefit from improved primary care records, proper coding and longer inclusion period.
312 Assessment and management of atrial fibrillation in primary care audit
The NICE clinical guideline CG180 (June 2014), for the management of atrial fibrillation (AF), suggested significant changes in the assessment and management of patients with AF. These included the use of CHA2DS2-Vasc and HASBLED risk stratification tools, with aspirin no longer a recommended treatment.
The aim of this audit was to identify the significant number of practice patients the guidance change had the possibility of affecting to assess and subsequently improve patient care through adherence to national guidance. Retrospective data were collected using the EMISWeb audit tools including searches and auto reporting. Patient demographics and dates of assessment were also collected.Following the results of the initial audit, a new practice protocol was designed, implemented and presented practice wide. This included the addition of an expanded HASBLED scoring tool for use by the practice nursing staff. Initially, 190 patients were identified.
At re-audit, an expected increase was observed, with a total number of 197. The percentage of patients with CHA2DS2-Vasc recorded increased from 76.8% to 80.7% (3.9%). A similar increase of 3.6% was observed for HASBLED. There remained significant numbers of patients for whom no HASBLED was recorded (68%), including patients that were actively treated with oral anticoagulation agents. Further data analysis was completed to explore the aetiology of the attained standards. Further recommendations to improve adherence to the updated clinical guidance included catch up risk assessments and incorporation of the expanded HASBLED tool on EMISWeb, in addition to further re audit following reinforcement of the practice protocol through communication.
313 An audit of cancer diagnoses
This audit was based on the RCGP National Audit of Cancer Diagnosis in Primary Care. A Macmillan evaluation of the practice profiles for cancer had also highlighted certain areas, most notably that the practice had a younger population than the CCG and UK average, an average number of cancer case deaths and 2 week wait referrals and a lower than CCG/UK average of new cancers treated being 2 week wait referrals.
The aim was to gain insights into the diagnostic pathway to cancer diagnosis at the practice, to inform learning and service improvement at the practice, in particular to identify if there were any systems which could be improved with regards 2 week wait cancer referrals. Patient demographics, types of cancer, place of initial presentation, number of GP consultations before referral, routes to diagnosis, intervals in the diagnostic pathway and stage at diagnosis were examined.
Findings were presented in a practice educational meeting and highlighted that certain cancers had higher number of GP consultations prior to referral, longer intervals before diagnosis and higher acute presentation. Some individual cases had been very commplex clinically. Notably, the percentage of cancer diagnoses made via 2 week wait referrals was much higher than the national figures in the National Audit or in the Macmillan practice data.
These findings showed that certain practice policies, particularly those in place for monitoring 2 week wait referrals once made were robust. Learning was shared in an educational meeting, focussing on new 2 week wait guidelines and those cancers with more acute and longer routes to diagnosis. These findings also enabled discussion with the Macmillan team to examine discrepancies in data and coding.