Implementing new guidelines for managing CHD
North Dorset 2004
With the help of its PRIMIS+ facilitator, North Dorset PCT* has used data analysis to ensure that the care of patients with CHD, or at risk of developing it, is managed better.
 Newly adopted Dorset and Somerset guidelines for managing CHD mean that more patients will require primary and secondary treatment. The guidelines have reduced the cholesterol threshold level beyond which patients should be prescribed statins. They advise primary treatment for patients at a lower risk level than before and they also advise statin treatment for all patients over the age of 35 years with diabetes.
It has been the task of the PRIMIS+ facilitator, Sue Hughes**, to quantify how many more patients are now regarded as 'at risk' from CHD and how many require more active management of their disease or risk factors. Among the 38% per cent of the PCT's patient population who have at least one risk factor for developing CHD, up to 4750 extra patients will be prescribed statins across the PCT if the guidelines are followed to treat patients to the lowest 15% Framingham CHD risk threshold. This would not only increase prescribing budgets but also multiply the number of annual reviews and cholesterol tests to manage the enlarged risk group.
 As well as resource implications, the audit has revealed some data quality issues for monitoring patients at risk from CHD. Sue has made several recommendations which aim to make the reporting of primary CHD prevention more robust. Risk scores should be assessed and recorded routinely for more patients, especially for those with multiple risk factors. Cholesterol levels should be recorded in more detail - HDL-C and LDL-C levels as well as total serum cholesterol - to provide a more sophisticated analysis of the effectiveness of statin treatment. Lists of patient IDs which show a significant risk profile could be supplied to practices in order to build registers of patients at high risk of CHD.
The audit prompted by the new guidelines has provided an opportunity to analyse how risk factors like high blood pressure, obesity and smoking intersect with CHD among patients in North Dorset. Sue has also analysed additional factors, including patient gender, age and locality. This comprehensive evidence base has made it possible to ensure that care for patients with, or at risk of developing CHD is managed better across the PCT.
* Since this case study was first produced, North Dorset PCT was amalgamated into Dorset PCT, following the 2006 PCT restructuring.
** Sue Hughes is no longer a PRIMIS+ facilitator. |
