Transcript Deprivation and Health a GP perspective

Deprivation and Health
a GP perspective
Petra Sambale
Possilpark Health Centre
Glasgow
[email protected]
Deprivation and Health
 89% of patients belong to the most deprived
15% of postcodes
Deprivation and Health
 And you?
 Where do you meet my patients and what is
your experience?
Deprivation and Health GP
 Your experience:
Deprivation and health GP
 A surgery
 1 year old with bronchiolitis
 30 year old with otitis, pmh of om,
mastoiditis,CIN2 and deafness, should wear
hearing aid, too embarassed, mother died 2005,
carer for younger brother and 8 year old child,
under investigation for Noonan syndrome,
autosomal genetic inheritance, short stature,
heart problems, delayed puberty
Deprivation and GP
 A surgery
 51 year old lady: iron def anaemia,
hepatosplenomegaly, granulomatous enteritis,
pruritus, restless legs, non alcoholic fatty liver
disease, obesity, Diabetes Type 2, depression,
diabetic neuropathy, polyarthopathy, OA knee,
hypercholesterolaemia, gastritis, aortic
incompetence, gallstones, asthma, works in
supported accommodation for young people
Deprivation and GP
 A surgery
 51 year female: in tears, sobbing, Saturday
night incidence at work where a young girl with
substance abuse had knife and was followed by
a gang of boys who wanted to fight her and had
entered premises
Deprivation and GP
 A surgery
 51 year old female
 What does this woman need?
Deprivation and GP
 A surgery
 27 year old man, lives with parents, has 2 sisters,
parents are kinship carers of 3 grandchildren, pmh of
depression, asthma, self harm and death of sister in
1989
 30 year old, mother of 2, with urti and unprotected
intercourse, pmh headache, domestic violence, hairline
fracture mastoid 2009, persistent headache and left drift
heel toe gait and romberg
GP and deprivation
 A surgery
 54 year old lady with epigastric pain, asthma,
hypercholesteraemia, obesity, weight loss,
hypertension, corrosive gastritis, on ppi’s,
breath test negative
GP and deprivation
 A surgery
 45 year old lady phoned earlier to ask if sister
can come instead of her, as daughter at 37
weeks pregnancy in hospital with reduced fetal
movements and anaemia, needs letter for appeal
for ESA, PMH: obesity, depression
GP and deprivation
 A surgery
 40 year old female, PMH: anal carcinoma 2010,
chemotherapy, radiotherapy, acute coronary
syndrome 3/11, peripheral neuropathy,
premature menopause (radiotherapy), DNAs fu,
smear overdue, requires vaginal stretch, bone
densitometry, family history….
GP and deprivation
 A surgery
 Emergency appointment not booked
 27 year old female pmh sex abuse, self
harming, serious overdoses, lifelink support, ear
pain, headache, and police asked her if she
wanted report incident that happened in past
GP and deprivation
 A surgery
 40 year old male: depression, not been out since
last seen me 8 weeks ago, had dnaed one appt,
anxious, nervous, pmh: 92 death of sister, 92
death of mother, opioid dependency, 98 death
of father, off heroin for 8 weeks,(dealer from
upstairs moved out), changed antidepressant
GP and deprivation
 A surgery
 50 year old female, cervical smear 87 severe
dyskariosis, depression 2001, self harm, CVA
2006, carpal tunnel, hyperchoesterolaemia,
lymphocytosis, nov 11 with shortness of breath,
lymphocytosis, dry mouth, diagnosed diabetes,
discussed understanding, asking if needs
injections, www diabetes uk given, daughters
support, giving up smoking, also knee pain,
physio review then follow knee pathway
GP and deprivation
 After the surgery docman (hospital letters),
practice nurse meeting with discussion of
cases, chronic disease management,
telephone calls, medication review
GP and deprivation
 A medication review:
 Dihydrocodeine, fenofexadine, amlodipine,
aspirin, BFZ, Clenil, domperidone, humulin,
omeprazole, pravastatin, ramipril, salbutamol,
urea cream,
 Link diagnosis, check in chronic disease
monitoring, check concordance
GP and deprivation
 Interface with secondary care
 What are the issues:
GP and deprivation
 Interface with secondary care
 What are the issues and what can we do better?
GP and deprivation
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“ There is not a single boring day”
Learn to stay healthy
Multimorbidity keeps you up to date
Be prepared to take leadership
Continuity of Care and Time are paramount
Deprivation and GP
 Breast screening
 Uptake 49.5%
 Wos: 72%
 Scoltland 75.7%
Deprivation and GP
 QOF prevalence data
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Copd 99th centile
Epilepsy 99th centile
Heart failure 99th centile
Mental health 97th centile
Stroke/TIA 99th centile
Dementia 97th centile
Depression 98th centile