1 / 19

Primary prevention of cardiovascular disease Locally enhanced services and QRISK

Primary prevention of cardiovascular disease Locally enhanced services and QRISK. Sajid Khan GPST1 & Rose Kennedy GPST1 2013. Contents. Risk assessment tools QRISK2 Locally enhanced services LES / NHS health checks. Background. Cardiovascular disease (CVD) Stroke/TIA

maitland
Download Presentation

Primary prevention of cardiovascular disease Locally enhanced services and QRISK

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Primary prevention of cardiovascular disease Locally enhanced services and QRISK Sajid Khan GPST1 & Rose Kennedy GPST1 2013

  2. Contents • Risk assessment tools • QRISK2 • Locally enhanced services LES / NHS health checks

  3. Background • Cardiovascular disease (CVD) • Stroke/TIA • Myocardial infarction/Angina • UK’s biggest cause of death – 191 000/year • GPs play a significant role in the prevention of CVD • Evidence from RCTs supports the effectiveness of statins • Silent risk factors

  4. How to use risk assessment tools • The tool is an aid in modifying lifestyle, using anti-hypertensives and lipid-lowering medication • Patient centered approach – identifying ICE and patients preferences • A total CVD risk of over 20% over 10 years is considered high risk • People with moderate-to-high risk – lifestyle modifications and discuss options

  5. Risk assessment tools • Previously the Framingham study was used • A cohort study of affluent white patients in Framingham, USA • Underestimated risk for diabetic patients, the most socially deprived • Limited variables • Is familiar to GPs • Now shifted towards to QRISK2

  6. QRISK2 • Created from data of a cohort of 1.28 million anonymised UK primary care patients with no evidence of diabetes or CVD and followed for 10 years with CVD as an end point • Calculator available on EMIS, SystmOne and http://www.qrisk.org • Current version uses multiple parameters

  7. Website - http://www.qrisk.org/

  8. QRISK2 continued • Calculated risk is calibrated to the UK population • Additional variables such as obesity, social deprivation and ethnicity • Updated every year due to changing social norms (obesity rising, smoking falling) • Interactive with patients – changing variables http://www.qintervention.org/ • Less well established than Framingham Advantages Disadvantages

  9. Consultation skills – communicating risk • Risk Perception • Different concepts of health risk • Patients often believe that it’s the doctors role to look after their health • Patients often rational and logical in some areas but careless in others (eg well controlled diabetic who continues to smoke) • The doctor’s role • Personal choice and shared decision making • Meeting of experts – the doctor with a knowledge of statistics/medicine and your patient with their health beliefs and concerns • Accept that patients will continue to do things you disagree with

  10. Enhanced Services • Provide core (essential and additional) services to their patients. • Extra services they provide are called Enhanced Services

  11. Enhanced Services • Enhanced services are currently commissioned through your local CCG and can be delivered by a range of other service providers ‘AQPs’

  12. Enhanced Services • Local enhanced services (LESs) • Schemes agreed by CCG in response to local needs and priorities, sometimes adopting national service specifications. • Directed enhanced services (DESs) • Schemes that CCGs are required to establish or to offer contractors the opportunity to provide, linked to national priorities and agreements.

  13. National directions currently cover eight DES schemes • Childhood immunisation • Influenza and pneumococcal • Violent patients • Minor surgery • Extended access • Alcohol reduction • Health checks for people with learning disabilities • Patient participation

  14. Kirklees locally enhanced services • D-Dimer LES (GHCCG only) • TB LES • Minor Surgery for non-registered patients (NKCGG only) • Near Patient Testing • Treatment Room LES • Vasectomy • Zoladex//Prostap • Urgent appointments and urgent home visits for Kirklees residents registered with a GP practice participating in the 12/13 choice of GP practice pilot • Managing Diabetes • BP 24 Hours Monitoring • Care Homes LES

  15. Further LES • Implanon /Nexplanon • Alcohol Identification & Brief Advice (IBA) • Alcohol Shared Care • Drugs Shared Care • NHS Health Checks (Vascular) • Smoking Cessation • Weight Management

  16. NHS health checks • The NSF for Coronary Heart Disease recommended the identification and management of patients at high risk of developing Coronary Heart Disease. • NICE guidance-recommend patients, who do not have established Cardiovascular Disease (CVD) or diabetes, are risk assessed for CVD, and if their risk of a CVD event is found to be 20% or greater in the next ten years, are offered aspirin, statins and management of hypertension (if hypertensive) and reviewed on an annual (12 monthly) basis. • DOH- In April 2008 they launched the publication of “Putting Prevention First” which set out plans for the NHS to introduce a integrated programme of vascular risk assessment and management for those aged 40 and 74. These are now known as NHS Health Checks. • Ultimate aim: prevention of disease.

  17. NHS Health Checks

  18. LES:Future • As part of the changes to the NHS LES contracts have been transferred to Clinical Commissioning Groups and Kirklees Council from 1/4/13

  19. Summary • GPs play an important role in the primary prevention of CVD • Risk calculators should be viewed as only screening tools. • QRISK2 is UK specific and easy to use • NHS health checks – include QRISK2

More Related