Health Equity Audit of Coronary Heart Disease (CHD) and Diabetes Prescribing in South Wiltshire
| Description | To identify inequalities in prescribing key drugs for people with diabetes or coronary heart disease (CHD). |
|---|---|
| Setting | Primary care |
| Populationting | People with CHD or diabetes living in South Wiltshire |
| Intervention summary | Analysing the prescribing rates of beta-blockers and angiotensin converting enzyme (ACE) inhibitors for CHD patients, and ACE inhibitors for people with diabetes. |
| Outcome Summary | There were variations in the prescribing rates of beta-blockers and ACE inhibitors for CHD patients and in ACE inhibitors for people with diabetes. |
| Startup Cost | £2500 |
| Running Cost | £500 |
| Funding | South Wiltshire Primary Care Trust |
| Started | August 2005 |
| Ended | August 2006 |
| Location | South Wiltshire, England |
| Contact |
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Background
This project aims to identify the inequalities in prescribing key drugs for people with diabetes or coronary heart disease (CHD).
What is the problem you are trying to solve?
We wanted to see if there were any inequalities in prescribing evidence based drugs for CHD and diabetes in general practices.
What local organisations are involved?
None
How many people are running this project and who are they?
One person: the acting joint director of public health, South Wiltshire Primary Care Trust (PCT).
What local population are you targeting?
People with CHD or diabetes living in Salisbury, South Wiltshire
How many people are you targeting?
Approximately 8000
Interventions
What interventions are you using to address the problem?
I am analysing the prescribing rates of beta-blockers and ACE inhibitors for CHD patients and ACE inhibitors for people with diabetes. The data came from local quality and outcomes framework (QOF) returns. The report was fed back to practices and the cycle is being repeated this year.
Is the project design based on evidence? If so, please state reference.
The evidence base for using beta-blockers and ACE inhibitors for people with CHD, and ACE inhibitors/A2 antagonists for people diabetes and mild renal impairment is very strong and summarised in the National Institute for Clinical Excellence and Scottish Intercollegiate Guidelines Network assessments and guidance 1 . It is given in the QOF manual.
Outcome
What outcomes or planned outcomes are you measuring?
We are looking for variations in the prescribing rates for beta-blockers and ACE inhibitors. We are also looking at exception reporting, where a person is excluded from the return for a variety of reasons (for instance, being terminally ill).
Do you have any outcomes or results yet? If so, what are they?
Yes. I have found that: (a) not all CHD patients are receiving beta-blockers; (b) not all patients with diabetes and renal impairment are being found; (c) and there is too much variation in the exception reporting.
The percentage of CHD patients who received beta-blockers ranged from 39% to 70% with a mean of 55% and the ineligibility percentages ranged from 0% to 44% with a mean of 15%.
The percentage of diabetes patients who have proteinuria or microalbuminuria and received ACE inhibitors/A2 antagonists ranged from 0% to 28% with a mean of 8% and the ineligibility percentages ranged from 0% to 99% with a mean of 66%.
We are repeating these analyses this year with feedback.
Is your project relevant to a government target or guideline?
Yes, the National Service Framework for Coronary Heart Disease 2 .
Feedback
What obstacles did you have to overcome to set up this project?
Initially, the data returns were inaccurate.
What have you learned about the project so far?
The project was very well received by the PCT Board, the Professional Executive Committee Board, the Clinical Governance Committee and staff.
What would you do differently?
I would ensure that training and guidance on exceptions reporting was given to all practices.
References:
- Scottish Intercollegiate Guidelines Network, Guideline number 55: The management of diabetes. 2001. Available at http://www.sign.ac.uk/pdf/sign55.pdf (accessed 5 April 2007).
- Department of Health. The National Service Framework for Coronary Heart Disease. 2000. Available at www.dh.gov.uk (Search for 16602; accessed 5 April 2007).