Transcript A GP’s Perspective of Diabetes Care in Southall

A GP’s Practical Perspective of
Diabetes Care in Southall
Dr A K Sandhu
Motivation / Vision

Glimpse of care in Southall / 1992
Challenges ?

The “INVERSE CARE LAW”
My Vision

Change the delivery of patient care

Challenge the Inverse Care Law

Create society with improved health
awareness
How ?

Educating the patients with goal oriented
advice

Emphasising on Primary Prevention of
Diabetes

Providing the self monitoring tools to patients
Practice Diabetes Care
New Diabetes pt Registration /
Identification
Practice Nurse
Seen by Clinicians
GP
 All needed Education and
Advice given.
 Baseline tests taken
Review after 3 months with
blood test reports. Review.
Continue monitoring progress
Thereafter always give goal
orientated education and
advice.
uncontrolled
controlled
Lifestyle
Advice
Di
et Exerci
se
Weig
ht
Monitor 4-6
weekly
Other
factors
 Dietetic Advice
 Podiatry Care (Annually)
 Health / Physical activity promotion
Practice Based Staffing

Dieticians

Health Care /Physical Activity Educators

Clinicians trained in Diabetes Care

Podiatrist

Dedicated Reception Team
Audit

Monitoring monthly audits

Outcomes (62% of patients achieved HbA1c ≤
7.4% in May 2004)
Belmont Health Centre
Diabetes QOF for May 2004
%
Total Practice Population
3249
Patients with Diabetes Type 1(13) + 2(173)
186
5.72%
Diabetes with Hypertension
142
76.34%
HbA1C <7.4
117
62.90%
HbA1C >7.4
69
37.10%
HbA1C >10.0
14
7.72%
HbA1C <10.0
172
92.47%
Blood Pressure Controlled (<140/80)
144
77.42%
42
22.58%
Cholesterol <5
145
77.96%
Cholesterol >5
41
22.04%
Microalbuminuria Nagative
118
63.44%
Microalbuminuria Positive
68
36.55%
152
81.72%
34
18.28%
Serum Creatinine Normal
165
88.70%
Serum Creatinine Raised
21
11.29%
Blood Pressure Uncontrolled (>140/80)
No Diabetic Retinopathy
Diabetic Retinopathy
Southall Health Improvement Project
(SHIP)

Health promotion for the Community in
Southall (evidence available)
What’s new

SHIP link with GP network (last Wednesday of
every month)

One of the areas to be covered will be
Diabetes Risk Assessment targeting 16-35
year olds
Local provision – what’s needed ?

Gap between Primary and Secondary Care needs to
be bridged by improving communication systems (GP
education seminars / regular updating and evaluation
meetings)

Cohesion in services provided both in Primary and
Secondary care - by Clinicians, Diabetes Specialist
Dietetics, Physical Health Educators and
Pharmaceutical companies working together, under
the organised project of Diabetes Risk Assessment
Framework.
Diabetes nGMS vs Practise
Diabetes care
Diabetes Mellitus Clinical Indicators
Register of patients with DM
Actual
Target
No of
points
available
100%
100%
6
BMI recorded in last 15months
95.20%
90%
3
Smoking status recorded in last 15 months
99.04%
90%
3
100%
90%
5
HBA1c recorded in last 15 months
96.12%
90%
3
HBA1c<= 7.4 in last 15 months
49.24%
50%
16
HBA1c<= 10 in last 15 months
84.20%
85%
11
Retinal screening in last 15 months
59.20%
90%
5
Peripheral pulses in last 15 months
67.32%
90%
3
Neuropathy testing in last 15 months
66.83%
90%
3
BP recorded in last 15 months
97.13%
90%
3
BP<= 145/85 in last 15 months
71%
55%
17
Microalbuminuria testing in last 15 months
87.86%
90%
3
Creatinine testing in last 15 months
94.69%
90%
3
50%
70%
3
Cholesterol recorded in last 15 months
95.17%
90%
3
Cholesterol <= 5mmol/l in last 15 months
67.69%
60%
6
Influenza vaccination given in last 7 months
88.83%
85%
3
Smoking cessation advice given
Patients with proteinuria or microalbuminuria treated with ACEI or A2
Diabetes nGMS Targets Vs
Achievements
85%
Influenza vaccination given in last 7 months
88.83%
60%
Cholesterol <= 5mmol/l in last 15 months
Target
67.69%
90%
Cholesterol recorded in last 15 months
Patients with proteinuria or microalbuminuria
treated with ACEI or A2
Creatinine testing in last 15 months
Microalbuminuria testing in last 15 months
Actual
95.17%
Y
70%
50%
90%
94.69%
90%
87.86%
0.00 10.00 20.00 30.00 40.00 50.00 60.00 70.00 80.00 90.00 100.0
%
%
%
%
%
%
%
%
%
%
0%
50%
HBA1c<= 7.4 in last
15 months
49.24%
HBA1c recorded in
last 15 months
90%
96.12%
Target
Smoking cessation
advice given
90%
Actual
100%
Smoking status
recorded in last 15
months
90%
99.04%
BMI recorded in last
15months
90%
95.20%
Register of patients
with DM
100%
100%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
BP<= 145/85
0 0 in last 15
months
55%
71%
BP recorded in last
15 months
90%
97.13%
Target
Neuropathy testing in
last 15 months
90%
66.83%
90%
Peripheral pulses in
last 15 months
67.32%
Retinal screening in
last 15 months
90%
59.20%
HBA1c<= 10 in last 15
months
0.00%
Actual
85%
84.20%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Incidence of Myocardial Infarction

3 patients (0.1% of total practice patient
population) had a Myocardial Infarction event
from April 2003 till 2004

Of these three patients 1 patient from the
diabetic population experienced a MI event
during this period
Why try better care ?

Rewards both for the patient and the team

More cost effective for the NHS / Social
Services at various levels