Chronic Disease Management

Beyond QoF PaymentsDr Bruce Davies

Scope

What common diseases?Should they be formally managed?

FrequencyImportanceFollow up affects outcomeKnow what to doWhere is follow-up most appropriate?

Brainstorm

What conditions are important under these criteria?

Perhaps

DiabetesAsthmaCOPDHypertension? EpilepsyHigh risk drug users ie DMARDs etcContraception

CDM Payments

AsthmaDiabetesSmall fee per GP per yearCriteria to claimRequirement for audit

Ways and Means

OpportunisticDedicated clinicsNurse led clinicsSpecific appointmentsDisease registersProtocolsGuidelines

Better Care or Just PC

Sometimes hard to tell!Evidence for effectiveness?Need for auditMore workMore treatment

More iatrogenic problems?

Polyclinic Model of Care

The list of things can grow and grow.Advantages.Disadvantages.Professional satisfaction.Quality.Fragmentation.Fall between two stools.

Generalist Model

Copes with everything.Advantages.Disadvantages.Professional satisfaction.Holistic.Failure to care systematically.

Registers

Creation.Maintenance.Accuracy.Usage.Whose responsible?Manual viz. Computer.

Protocols

Authority.Ownership.Access.Who follows.Benefits.Disadvantages.GOBSAT viz. EBM.

Records

Whose responsible?Paper or computer?Accuracy.Meaning.Why poor?

Audit

PC or use?Who does?More work for what value?Do people change as a result?