NHS Bromley CCG. Map of NHS Bromley CCG

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1 The Diabetes Community Health Profiles bring together a wide range of data on diabetes in adults into a single source for the purposes of benchmarking. A Diabetes Community Health Profile is available for each CCG in at It was last updated on 24 June Map of Contains Ordnance Survey data Crown copyright and database right 2013 Key facts for The prevalence of diagnosed diabetes among people aged 17 years and older in is 5.1% compared to 5.7% in similar CCGs. In 2011/ % of adults with diabetes had a HbA1c measurement of 59mmol/mol or less. This is lower than in other similar CCGs and lower than. People with diabetes in Bromley PCT were 86% more likely to have a myocardial infraction, 32.1% more likely to have a stroke, 57.4% more likely to have a hospital admission related to heart failure and 43.3% more likely to die than the general population in the same area. Spending on prescriptions for items to treat diabetes in 2011/12 cost per adult with diabetes in NHS Bromley CCG compared to across.

2 % of population % of population Demographic Charateristics and Predictive Factors for Diabetes Age Structure of Population Females Males -6% -4% -2% 2% 4% 6% Age is a key factor in diabetes prevalence. Type 1 diabetes tends to be diagnosed in childhood but the prevalence of Type 2 diabetes increases steadily after the age of 40 years. Diabetes prevalence is higher in areas experiencing deprivation. People living in the 2 most deprived neighbourhoods in are 56% more likely to have diabetes than those living in the least deprived areas. It is known that people from Asian and Black ethnic groups are more likely to have diabetes and tend to develop the condition at younger ages. Source: 2011 Mid-year population estimates Deprivation Ethnicity 4 35% 3 25% 2 15% 1 5% Most deprived Source: IMD2010 and 2011 Mid-year population estimates Least deprived 9% 8% 7% 6% 5% 4% 3% 2% 1% Asian Source: 2011 Census Black CCG Diabetes Classification Area Classification Groups The CCG Classification Groups provide a grouping of CCGs that have similar characteristics to allow appropriate benchmarking. It uses the following data to assign CCGs to the best match CCG Classification Group. Age structure of the population % of population from Asian ethnic groups % of population from Black ethnic groups Indices of Deprivation 2010 (average score) Population density is in The orange group has a population with an average age structure, average deprivation levels and a low population density.

3 Blood Pressure <140/80 Cholesterol < 5mmol/l HbA1c <59mmol/mol Quantifying Quantifying Diabetes diabetes In 2011/12 there were 13,269 people aged 17 years and older diagnosed with diabetes in and it is estimted that there are a further 5704 adults with undignosed diabetes. The chart below compares the prevalence of diabetes in with the cluster group and as a whole. 8% 7% 6% 5% 4% 3% 2% 5.1% 5.7% 5.8% 7.2% 7.1% 7.4% 1% Diagnosed diabetes Total estimates diabetes Source: Quality and Outcomes Framework, 2011/12 Care Processes Clinical Management and Treatment of Diabetes Targets The chart below provides a breakdown of the key aspects of clinical management of patients with diabetes and highlights the attainment of HbA1c, blood pressure and cholesterol targets in the 15 months ending March Within recommended limits Checked and outside recommended limits Excepted from indicator 61.7% % OrangeGroup 63.7% 26.4% 9.9% 62.9% 27.1% % 18.5% 7.7% 74.3% 16.1% 9.6% 73.9% 16.5% 9.5% 60.2% 32.8% 7.1% 65.8% 26.6% 7.5% 65.2% 27.1% 7.7% Source: Quality and Outcomes Framework, 2011/12

4 F83672 F83602 F83049 F83677 F83043 G84002 F83061 G84025 F83059 G84027 F83042 F83011 F83020 F83046 Y02811 F83040 F83048 G84032 G84022 G84007 G84628 G84627 G84015 G84028 F84060 G84621 F83044 G84016 Y00542 G84040 F83058 G84006 G84037 F83623 G84039 G84017 F84038 G84034 G84018 G84020 F84601 F83057 F83050 G84024 G84030 F83615 F83682 F83672 F83602 F83049 F83677 F83043 G84002 F83061 G84025 F83059 G84027 F83042 F83011 F83020 F83046 Y02811 F83040 F83048 G84032 G84022 G84007 G84628 G84627 G84015 G84028 F84060 G84621 F83044 G84016 Y00542 G84040 F83058 G84006 G84037 F83623 G84039 G84017 F84038 G84034 G84018 G84020 F84601 F83057 F83050 G84024 G84030 F83615 F83682 F83672 G84628 F83061 Y02811 F83046 F83677 F83043 F84038 F83049 G84028 F84060 F83042 F84601 G84027 G84034 G84024 G84016 F83602 G84025 G84007 G84002 G84015 G84022 F83040 G84017 Y00542 F83050 G84020 G84018 G84627 F83048 F83059 G84030 G84037 F83044 F83011 F83020 G84040 F83623 F83058 G84039 F83057 G84006 G84621 G84032 F83682 F83615 HbA1c Practice Quantifying level variation diabetes In there are 47 practices. The charts below show the variation in treatment targets at practice level. At practice level the proportion of patients whose last HbA1c was less than 59mmol/mol ranges from 39.4% to 81.2% Checked and <59mmol/mol Checked and outside recommended limits Excepted from measurement Cholesterol Checked and <5mmol/l Checked and outside recommended limits Excepted from measurement Blood pressure Checked and within target Checked and outside recommended limits Excepted from measurement Source: Quality and Outcomes Framework, 2011/12

5 Prevalence Incidence of of Complications The National Diabetes Audit collates data that identifies the additional risk of diabetic complications and mortality in people with diabetes compared to the general population. This data is currently only published by PCT and the best match for is Bromley PCT. Compared to the general population, people with diabetes in Bromley PCT were 86% more likely to have a myocardial infarction and 32.1% more likely to have a stroke. They were also 57.4% more likley to have a hospital admission where heart failure was recorded. In Bromley PCT people with diabetes have a 43.3% greater chance of dying in a one year period than the general population Bromley PCT Patient Experience Patient Perspective 329% 283% % 144% 5 86% 63% 71% 48% 57% 65% 32% 25% Angina MI Heart failure Stroke RRT Minor Source: National Diabetes Audit 2010/11 amputation The chart below shows the percentage of all people with a long term condition that have received enough support from local organisations and how confident they feel about managing their own health from the GP Patient Survey. Please note these data refer to all people with a long term condition not just those with diabetes % Major amputation 43% 4 Mortality % 91.3% 91.1% % Received enough support Very or fairly confident of managing own health Source: GP Patient Survey 2012

6 Spending on on Diabetes Care and and Outcomes Quadrant analysis charts (shown below) plot spending against an outcome measure. The cost and outcome measures have been standardised to allow direct comparrisons across different scales. The outcome is the percentage of patients with a HbA1c of 59mmol/mol or less. The cost data has been adjusted to take account of the number of people aged 17 years and older diagnosed with diabetes. CCGs within the dotted box do not have a statistically significant different level of spending and outcomes than as a whole. Total spending on anti-diabetic items The chart below shows the total standardised Net Ingredient Cost (NIC) of all prescriptions for items to treat and monitor diabetes per patient diagnosed with diabetes between April 2011 and March 2012 against the standardised proportion of people with a HbA1c measurement of 59mmol/mol or less for 2011/ All CCGs 1 Group - Orange Source: Information Centre, 2011/12 and Quality and Outcomes Framework, 2011/12 95% Confidence Box Average cost per item for anti-diabetic items 3 2 All CCGs 1 Group - Orange Source: Information Centre, 2011/12 and Quality and Outcomes Framework, 2011/12 95% Confidence Box spent a total of on prescriptions for diabetes items between April 2011 and March This was equivilent to per adult with diabetes. Average spending on items to treat diabetes was lower in compared to but this difference is not statistically significant.