PRIMIS in collaboration with Raj Sengupta, Consultant Rheumatologist at the Royal National Hospital for Rheumatic Diseases, Bath has developed a clinical system protocol and alert which runs in both EMIS Web and TPP SystmOne GP IT systems thanks to sponsorship from Novartis UK Ltd1. This tool has been designed to be used as a decision aid for clinicians managing patients with chronic back pain and includes prompts and pop-up messages to help with earlier diagnosis of axial Spondyloarthritis (axSpA)2.
The protocol is activated when patients under 45 years old present with recurring back pain. A pop-up message appears on-screen, prompting the GP to consider axSpA as a possible diagnosis. The fundamental aim of the project is to improve both screening and time to diagnosis of axSpA in general practice. Delay in diagnosis of axSpA is associated with worse outcomes for patients3. One of the reasons for any delay in diagnosis is due to the small proportion of axSpA patients within the vast number of patients presenting with back pain to primary care. [LF1]
Working with pilot practices in Bath and North East Somerset CCG and following analysis of data over an 18 month period, the protocol was found to be effective at identifying patients appropriate for further investigation and referral. The tool had been specifically designed so it does not overburden clinicians and this efficiency had been shown to be effective during the pilot.
Moving forward, it is hoped the protocol will be made available for wider use across general practice in England. further taken up across the UK across and made available in all major GP IT systems. Another future intention is that following wider use, the tool’s success in identifying patients with axSpA can be tracked and reported upon through collaboration with secondary care rheumatology.
Please get in touch with PRIMIS if you are interested in this protocol by emailing PRIMIS
PRIMIS can produce specifications in SNOMED CT.
We have already successfully developed data extraction specifications for NHS England in SNOMED CT for the meningitis, pneumococcal and rotavirus vaccination programmes.
More recently we have been commissioned to perform a bridging study examining the impact of SNOMED CT implementation on general practice data reporting.
Despite oral anticoagulation (OAC) being proven as very effective in preventing most strokes due to AF, patients across England are still being treated with antiplatelet monotherapy to prevent strokes due to atrial fibrillation (AF).[1] Aspirin should be considered as an ineffective stroke prevention treatment option and studies have shown it to have similar risks to anticoagulation in relation to bleeding, particularly in elderly patients.[2,3]
Nene CCG recognised the potential benefits of optimising the management of AF, particularly in terms of stroke reduction. This led to an area-wide initiative led by Dr Yassir Javaid, who is the cardiovascular lead for the CCG. The GRASP-AF quality improvement tool played an important part in this initiative as it allows practices to systematically identify high-risk AF patients who have not been anticoagulated (amongst other features).
The project, driven by the CCG, began with comprehensive training on all aspects of AF including diagnosis, management and the need for improvement. At least one GP from every practice attended these sessions to share learning and receive training. PRIMIS provided an introduction to the GRASP-AF quality improvement tool, including a session on how to download, install and run the tool.
The majority of practices in the CCG then conducted a review of patients with AF, many of them using the GRASP-AF quality improvement tool. The reviews focused on patients who were previously exception reported for anticoagulation or were on aspirin therapy (reviews conducted between September 2014 and March 2015). Some practices also used PRIMIS’ Warfarin Patient Safety quality improvement tool to identify patients who were poorly controlled on warfarin and in need of treatment optimisation.
"The opportunity and motivation were clear... optimisation in AF would benefit us in terms of reduction in strokes. SSNAP* data reinforced the devastating consequences of not doing the work."
Dr Yassir Javaid Cardiovascular and Diabetes Clinical Lead Nene CCG *Sentinel Stroke National Audit Programme
553 relevant patients were reviewed in the CGG initiative. Of these patients:
References
The International Journal of Clinical Practice (IJCP) will shortly publish an article entitled "Polycystic Ovarian Syndrome: assessment of approaches to diagnosis and cardiometabolic monitoring in UK primary care". This article, which can already be viewed online has included the involvement of our very own Dr John Robinson. [Jan 2018]
John performed the analysis of the raw data, including the chronological alignment of patients' details to facilitate the timeline comparison. This enabled the scrutinisation of checks, tests and scan occurrences to be made in direct comparison across all records, no matter when the diagnosis was made.
One thousand seven hundred and ninety-seven women were identified from a pooled GP practice database. The search included all patients defined with PCOS or related terms. Records included demographic information, medical history (diagnoses), blood test results and whether a pelvic ultrasound scan had been performed. Using data from the 1,797 patients across 42 GP practices in Central and Eastern Cheshire, the search using Read codes included all patients defined using search terms covering ‘polycystic ovaries (PCO)’ or ‘polycystic ovarian syndrome (PCOS)’ and was performed with the assistance of EMIS®, the provider of GP operating systems in this area. Individuals were included if they had been diagnosed with PCOS/PCO between 1 January 2005 and 4 August 2016. The study was performed with the approval of the local research ethics committee.
You can read the full article online via the Wiley online library:
Polycystic Ovarian Syndrome: assessment of approaches to diagnosis and cardiometabolic monitoring in UK primary care
PRIMIS is proud to support the NHS RightCare programme currently being rolled out across Clinical Commissioning Groups (CCGs) in England. Our clinical quality improvement tools and services can help to address RightCare indicators and support success in practice.
Asthma Care quality improvement tool
GRASP-DM
GRASP-AF and Warfarin Patient Safety tools
GRASP-COPD
NHS RightCare’s ambition is to reduce unwarranted variation through relentlessly focusing on value in healthcare. It is a proven approach that has both improved outcomes and freed up funds for further innovation where it has been implemented on a pilot basis at local health economy level. RightCare was launched to all health economies in 2016 by NHS England by a team of Delivery Partners and dedicated national functions.
The RightCare approach is a key initiative to drive delivery of the Five Year Forward View (The Five Year Forward View (published October 2014, NHS England) set out a positive decision for the future, based around seven models of care).
PRIMIS and NHS RightCare indicators
In May 2017, over 100 delegates joined PRIMIS staff and NHS and industry experts to discuss recent developments and to ask if we're fit for the future where SNOMED CT is implemented.
As part of PRIMIS’ ongoing commitment to support, training, software and quality improvement tools through SNOMED CT implementation and beyond, we have now run two successful national SNOMED CT events.
This report looks at the key points of interest raised by speakers and PRIMIS staff at SNOMED CT Update - fit for the future, the PRIMIS event held in May 2017. The event looked at how to prepare for the challenges and make the most of the opportunities that implementation will bring.
Download the PDF summary report
Applied Health Research Building University Park University of Nottingham Nottingham, NG7 2HA