Patients with diabetes are at high risk of cardiovascular disease and aspirin is an important part of prevention strategies. Although it is effective and relatively well-tolerated, studies have shown that many patients with diabetes are not taking aspirin. In this article, we review why aspirin should be considered in patients with diabetes, the benefits it might achieve and areas where caution is required.
Making sense of the Quality and Outcome Framework of the new GP Contract
The Quality and Outcome Framework (QOF) of the new GP Contract will be the biggest experiment in improving the quality of care for patients anywhere in the world. By April 2005, we will see how well Primary Care can deliver. In this series, we provide a step-by-step guide on how your practice can get QOF points, including practical information on what data to collect and how to record it. Over the coming months, we will be discussing the best ways to maximise the quality of care and will concentrate on the cardiovascular and diabetes elements of the QOF. We will discuss the setting up of registers, practical tips, examples from practices that are delivering well, how to check how well you are doing from your own IT system and from Quality Management Analysis System and, of course, how to deal with exception reporting and the PCT QOF visit.
Oily fish and cardiovascular disease
The management of cardiovascular disease (CVD) in primary care has been transformed in recent years, particularly with extensive use of statins in secondary prevention. But what about the less high-tech approach of getting patients to eat more healthily? Dietary advice has traditionally been offered primarily to those needing to lose weight or lower their lipid levels. But more recently, systematic reviews have shown good evidence that dietary changes can reduce mortality and morbidity in addition to modifying some risk factors in patients with coronary heart disease. Evidence to date suggests similar benefits of healthier eating are likely in primary prevention. In this new series – Food for Thought – we sort the wheat from the chaff when it comes to dietary advice for patients with cardiovascular disease. This article will focus on the benefits of oily fish, with the good news that simply increasing oily fish intake achieves major benefits.
Practical approaches to empowering people with cardiovascular disease or diabetes
For people with long-term conditions, self-care can have as much, if not more, influence on their health than prescribed medication and treatment. Yet, in many cases, healthcare professionals become frustrated when attempts to improve peoples’ self-care behaviours prove unsuccessful. This article looks at some of the reasons why it can be difficult to encourage people with diabetes or cardiovascular disease to look after themselves effectively; what types of practice can help us to increase people’s success in managing long-term conditions; and how we can incorporate empowering techniques in our day-to-day consultations.
Sex after an MI
Rehabilitation after a myocardial infarction (MI) includes all aspects of a patient’s life – medical, physical and social. Sexual functioning is an important part of most people’s lives. Fears about whether having sexual intercourse could trigger another heart attack is the question many post-MI patients want to ask but embarrassment may stop them. Giving accurate information about sex after an MI is just as much a part of patient education as telling them about cholesterol and blood pressure and can go a long way to helping recovery and preventing further problems such as sexual dysfunction.
Stroke and TIA
Stroke is common, affecting around one in four people over the age of 45 at some time in their lives. Increasing age is a major risk factor for stroke, so the numbers of people suffering a stroke will increase with the ageing population. Primary care teams have a central role in providing effective secondary prevention, but because patients often fall between primary and secondary care, things may be missed. Taking a systematic approach to assessing risk factors, such as blood pressure, and treating them effectively can significantly reduce further stroke risk.
Quality … and beyond
Quality is the latest buzzword in healthcare. The latest GMS contract emphasises this in the Quality and Outcomes Framework (QOF) designed to measure and reward key elements of primary care chronic disease management. In this issue of BJPCN we start a new series – Points mean Prizes – on how to make sure you get all the ticks in the boxes for the data you need to collect to get maximum QOF points. The series will provide a step-to-step guide on how to score on the 76 quality indicators in the 10 clinical domains of care.
Bringing CHD management back to primary care
Managing heart failure effectively in the community Community-based nurses are at the forefront of vigorous efforts to improve the management of coronary heart disease. The Coronary Heart Disease Collaborative is spearheading 30 projects around the country to find practical ways forward. This issue reviews how Durham Dales PCT has brought the management of heart failure firmly back into primary care, with up-to-date registers of heart failure patients and regular clinics in the community.
Getting it right – how to measure BP in the surgery
It’s something that we do so often, but are we always doing it the best way? Check out how to measure blood pressure (BP) correctly, with latest advice from the National Institute for Clinical Excellence and the British Hypertension Society.
Expanding the role of health care assistants in primary care
As practice nurses take on a growing role in the organisation and implementation of chronic disease management, they need more help in many of the routine – but important – tasks this involves. Health care assistants (HCAs) are providing growing support in this capacity. This article explores what HCAs are taking on and issues regarding their training and regulation.
Chest pain in Primary Care – would you and your team know what to do?
This article considers a possible scenario in primary care in which a patient presents with chest pain. Test yourself to see what you would do. Then check this against our recommendations, reflecting on your current procedures and policies within your practice.
Making sense of heart failure and its treatment
Heart failure is a high priority in primary care, with the National Service Framework for Coronary Heart Disease, the NICE Heart Failure Guidance, and the new General Medical Services contract quality indicators all setting clear standards for improving the management of patients with this increasingly common condition. This four-page pull-out supplement provides you with a need-to-know, need-to-keep guide.
