Tina Huang

Aimed at people aged 40 – 74

Risk assessment and management programme to prevent or delay the onset of diabetes, heart and kidney disease and stroke

CVS risk – Age Gender smoking status physical activity FH of coronary heart disease Ethnicity BMI cholesterol test (random) Blood pressure

◦All required for Qrisk score

Diabetes risk – Identifying high risk (BMI/BP) Hb1ac or FBG

Alcohol risk ◦ Initial screen – Audit C or FAST◦ Second phase - Audit

Dementia – Age 65 – 74 ◦ Signs and symptoms of dementia, raise

awareness no formal assessment◦ Memory services signposted

Follow up – face to face with lifestyle advice, diagnosis coded

Risk assessment ◦ To see if all the tests and measurements are

being carried out◦ To see if they were done correctly

If they were not carried out then assessing the possible reasons

To review if the abnormal findings were followed up

During a NHS health check 100% of patients must have – age, gender, ethnicity, smoking, FH of CVD, BP, BMI, physical activity, auditC/FAST, Cholesterol, Qrisk, dementia awareness, diabetes risk, lifestyle advice, and to have diagnosis coded

If any were abnormal then must have follow up

Coding searched:NHS health check completed

were searched on Emis 890 patient’s found Around 1 in 20 were selected No. of pt audited – 47

All but 1 patient were eligible

Ethnicity – 11% documented

Smoking – 74% documented◦ 5 out of the 6 patients who were smokers were offered

smoking follow up

FH of CVD – 60% documented

Blood pressure – 94% documented◦ 8 out of 13 patients at risk did not have follow up

BMI – 89% documented◦ 7 out of the 23 patients at risk were not signposted

Physical activity – 77% documented◦ 4 out of the 11 patients at risk not signposted

AuditC/FAST – 27% documented◦ All of the 2 pts that needed follow up did not have follow

up

Diabetes – 74% had Hb1ac◦ 5 out of 5 patients who had abnormal levels had follow up◦ 7 out of the 12 patients (who did not have a Hb1ac) -

Blood requested but bloods not done

Cholesterol – 83% had lipids done◦ 7 out of 8 pts (who did not have lipids done) – Bloods

requested but pt had not done blood test

Qrisk – 87% documented◦ Documented despite no cholesterol level◦ Qrisk follow up – 4 out of 5 were followed up and

started on statins

Dementia – 4 patients were over 65 y/o, 2 of these patients had memory service signposted to them (50%)

57% patients did have face to face follow up

47% patients received lifestyle advice

100% patients had their diagnosis coded

7 patients were issued blood request forms, however these were not done, and had no follow up - These were still coded as NHS health check complete

Values for ethnicity and FH of CVD inaccurate due to limitation of template

AuditC/FAST scores on 3rd page ◦ Of the 2 patients that were identified to be at risk,

no follow up was recommended

Blood pressure, 8 patients had no follow up appt made, patients had no set follow up date

Need to signpost weight management services and exercise services

Qrisk and diabetes follow up very well

Age over 65 – need to signpost memory services

1 pt who was not eligible – Qrisk was not followed up as age 79, Qrisk >30, already on statins

Adjusting the NHS health check template◦ Audit C score being on the first page◦ Having the option of ‘no family history’ on FH of CVD◦ Making selecting a follow up date compulsory on the

template Follow up

◦ ensuring a follow up date is made Coding of NHS health check indicated if blood

tests not completed/ consider giving patients blood test forms prior to their NHS health check appointment

Raising awareness – dementia, audit C score

Performing the audit C/FAST score, dementia awareness could be improved◦ Possible reasons for above could be due to

location on NHS health check template, not aware to document dementia awareness

Follow up may be improved if a follow up date is selected during NHS health check◦ Blood pressures that need follow up – arrange

follow up date during consultation Coding ‘NHS health check completed’ post

blood test results