A Primary Care Trust Perspective NHS North Lancashire.
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Transcript of A Primary Care Trust Perspective NHS North Lancashire.
![Page 1: A Primary Care Trust Perspective NHS North Lancashire.](https://reader036.fdocuments.in/reader036/viewer/2022062408/56649efd5503460f94c11c94/html5/thumbnails/1.jpg)
A Primary Care Trust Perspective
NHS North Lancashire
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PCT PerspectivePCT Perspective
• Corporate Objectives• Commission health care• Improve health outcomes• Reduce health inequalities• Achieve financial balance
• ‘Patient Safety First’• Whole-systems thinking• Not experts in VTE
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VTE Improvement Cycle
Raise awareness
Measure
Understand
Set standards
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Sources of data
• Primary Care– PRIMIS– QoF
• Secondary Care– Regional Data Warehouse (SUS)– CHKS– Hospitals’ own –
pathology/haematology
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Primary Care Prevalencefrom PRIMIS searches
Total number of patients diagnosed with either DVT or PE as a % of a total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)
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Primary Care Patients on Warfarinfrom PRIMIS search
2811
505
383
No of Pts without eitherDVT or PE prescribedWarfarin between01.11.08 - 31.01.09
No of Pts with DVT andWarfarin
No of Pts with PE andWarfarin
Total number of patients prescribed Warfarin (in last 3/12) from the total GP population of 298,371 (5 practices data was not included due to discrepancies in the data collection)
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2005-2006
2006-2007
2007-2008
UHMB
BVH
LCT
Other
Total
Annual Hospital Incidence from SUS data.
Data from Cumbria & Lancashire Commissioning Intelligence Support (CaLCIS)North Lancashire Residents (population 340,000).
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Benchmarked Benchmarked Analysis of Venous Analysis of Venous Thromboembolism Thromboembolism
2006-2008 data2006-2008 data
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Venous Thromboembolism – primary or secondary position
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Venous Thromboembolism – Length of
Stay by type 2008 only
NHS North Lancashire - Population 340,000.
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Venous Thromboembolism – mortality rates
2008 only
NHS North Lancashire – Population 340,000
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VTE Improvement Cycle
Raise awareness
Measure
Understand
Set standards
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Commissioning for Quality
• What is quality?– Safety, efficacy, personalisation, outcome
• ‘Advancing Quality’ – carrots v sticks• Risk Assessment for all hospital
admissions embedded in contracts• Financial support to providers• PCT Project Manger for VTE to monitor
and support– Audits / Root Cause Analyses/ Trajectories
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Refining DVT diagnosis in primary care
• >140,000 referrals for ?DVT/year in UK• 80 – 90% do NOT have DVT• Need to refine tests in primary care• Clinical Decision Process including near-
patient-testing• ‘Safely Ruling out Deep Venous Thrombosis in
Primary Care’. Buller et al. Ann intern Med. 2009; 150:229-235
• One PBC consortium implementing.
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VTE Mind Map from PCT Perspective
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Project Plan
• Understand the data and the issues• Raise awareness• Set standards in contracts• Support improvement initiatives• Measure outcomes• Link VTE to other initiatives• Manage the project through a Lead• Share learning
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Questions
• In our PCT area, our two acute hospital trusts have different heparin regimes at discharge. This causes confusion for our community staff.
• In the interests of safety, should we (as a PCT) seek to standardise heparin protocols across our health economy?
• Should we, as an exemplar community, look to standardise heparin protocols across England?