Sunderland Teaching PCT uses PRIMIS to improve patient care and public health

Sunderland 2007

Two Disease Register Facilitators at Sunderland Teaching Primary Care Trust (TPCT), Jackie Storey and Nancy Davison, part of the Clinical Governance, Research and Audit Team, have been involved in a number of diverse projects relating to both improving public health and the care of individual patients. These mini case studies outline these varying projects.

Dementia

To establish the prevalence of dementia across the city, Nancy wrote a simple MIQUEST query set to collect numbers. The results were used in two pieces of work: one to address data quality, and the other to develop a project to improve early detection of dementia in primary care. The second project supports collaborative working between South of Tyne and Wearside Mental Health, Sunderland TPCT and Primary Care.

Diabetes, Heart Disease and Stroke

The City of Sunderland is taking part in a national project looking at diabetes, heart disease and stroke.

Jackie and nancy helped by producing a query set designed to provide information for the specialist heart disease nurse involved in the project that will enable her to monitor the project's progress alongside the Health Care Assistant's information. The facilitators are currently collecting, uploading and analysing the returns.

Obesity

To establish the prevalence of obesity in Sunderland, Jackie wrote a MIQUEST query to establish BMI and waist circumference values. Tobacco consumption was also looked at to give a better lifestyle overview. Approximately 50 practices out of a total of 54 across the city were involved.

The results of all those identified as clinically obese were cross matched against patients diagnosed as having diabetes, ischaemic heart disease (IHD) and/or asthma to see if any obese patients had any of these conditions. After analysis by Sunderland TPCT's Health Development Unit, the results will be used to help develop the City's obesity strategy.

Ongoing Audit for CHD and Heart failure

Sunderland Teaching PCT has been helping with ongoing data runs, analysis and feedback for coronary heart disease (CHD) and heart failure.

Data runs are regularly carried out by practices with Jackie and Nancy's help as required. Data analysis and graphing of the results is undertaken by Sunderland TPCT's IT Department and feedback is passed to practices via Intranet and Extranet.

Practices can then compare and see how they are doing across the city and check that they are using the Sunderland recommended Read codes. The heart failure and CHD leads use the data to ensure National Service Framework standards are met.

Pre Diabetes

The University of Sunderland invited Sunderland TPCT to help with this particular pilot study involving five GP practices.

Firstly, Nancy and Jackie wrote a query set to identify all patients without a pre-existing diagnosis of diabetes, impaired glucose tolerance or impaired fasting glucose. Identified patients were then analysed against a number of factors which might put them at risk of developing diabetes. Risk factors were a family history of diabetes, personal history of gestational diabetes, hyperlipidaemia or hypertension, and a body mass index of more than 30. The facilitators also searched on ethnicity codes.

Details on those patients aged 30-70 identified as having at least three or more of these risk factors were sent the Finish Diabetes Risk Prediction questionnaire to identify those with a high risk of developing diabetes in the next 10 years. Patients with high scores (and therefore considered likely to be at high imminent risk of developing diabetes) were invited to have an oral glucose tolerance test - the "gold standard" - at a local hospital.

The intention of the project is to identify people with "pre-diabetes" where lifestyle modification can significantly reduce the likelihood of them going on to develop diabetes in the future. If the project is successful and the "pick-up" rate considered cost-effective, the process may be rolled out to other practices.

Severe Mental Illness Lists

To support the need of practices to identify patients suffering from severe mental illness, Jackie and Nancy wrote a query set to establish:

• Patients prescribed medication – with no diagnosis code recorded

• Patients with a diagnosis code recorded – but with no prescribed medication

• Patients referred to Mental Health Services – who either have no record of prescribed medication or coded diagnosis.

As part of a joint project between Sunderland TPCT and South of Tyne and Wearside Mental Health, a severe mental illness register project has been established. A mental health specialist nurse provides validation for the list by reviewing practices' medical records. This activity will support GPs in providing ongoing care for their patients.