22 April 2008 Implementing CVD risk assessment in Primary Care Julia Hippisley-Cox Department of...

22 April 2008

Implementing CVD risk assessment in Primary Care

Julia Hippisley-CoxDepartment of Health

22nd April 2008

22nd April 2008 QRisk © 2008 All rights reserved

Objectives

Thoughts on presenting risk to patients

Practical aspects of implementing CVD risk assessment in Primary Care

Patient ‘e’ record access - current realities & future vision


Presenting risk to patients

Patients need to know What is my risk of developing CVD? What can I do to reduce my risk? How effective will this be?


How best to present risk?

Keep it clear & simple Pictures say a thousand words Absolute AND relative risk Present in context of every day

things Give appropriate perspective “The bad news is your risk has doubled --- the good news

is its gone from one in a million to two in a million…..”


What is my risk?

CVD risk of 20% over 10 years Take a 100 people like you, and 20

will develop CVD over the next 10 years

(and 80 people wont!) Easier to understand than “one in

five”


How do I compare? Your risk is three times that of an

average risk for a person of your age/sex

0

5

10

15

20

25

30

My risk Average risk Risk with Rx


Effect of interventions

For smokers: what if stop smoking For overweight: what if loose weight High lipids: what if take statins BP treatment: what if BP treated If you do all of theseBut modelling the ‘what if’s” complex


CVD Risk Assessment Tool Kit On line web calculator for patients for

self assessment Downloadable risk calculator for docs Risk stratification tools for primary care MUST be v simple to use, quick,

accessible and make best use existing data

MUST get the RIGHT people and not widen health inequalities


Risk stratification tool kit –key goals

Utilities for all general practices to to auto-generate a risk recall

register based on ‘estimated risk’ Calculate an `actual risk’ within

the consultation Present risk and discuss effect of

interventions to patients


Risk stratification/recall list

Computer search to calculate score for all patients 35-74

Uses estimated values for SBP, BMI, cholesterol/hdl ratio where missing

Rank all patients and highlight which patients need what interventions


Clinical calculation actual risk

Utility to calculate ‘actual’ risk in consultation and present it back to patients

Explain likely effectiveness of interventions


Personalised plan & printable prescriptions

Item My risks My goals My actions

10 year risk of CVD 27 % (ie 27 out of 100)

Reduce this by half More exerciseSee GP 2 months

Smoking 20 /day Stop smoking Attend new leaf

Blood pressure 155/87mmHg Lower it < 140/90mmHg

Take tablets

Body mass index 37 kg/m2 Ideal <26 Loose weightattend weight group

Cholesterol 6.2 mmols/l Ideal <5mmols/l Low fat diettake statins if no better

eGFR (kidney test) 58 >89 Need further tests

Random Glucose 7.3mmols/l <6mmols/l Need further tests


Quote from a GP in London

“Obviously, the knowing the absolute risk reduction from treatment is essential for a patient to make an informed decision as to whether or not to accept treatment . We are currently doing them a great disservice, by not providing them with better information”.

22 April 2008 Implementing CVD risk assessment in Primary Care Julia Hippisley-Cox Department of...

Documents

Transcript of 22 April 2008 Implementing CVD risk assessment in Primary Care Julia Hippisley-Cox Department of...