GLP-1 Initiation and Follow Up. Version Date Summary of Changes 1.0 April 2013 This is a new template

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1 Template Control Page GLP-1 Initiation and Follow Up Template Guide Title GLP-1 Initiation and Follow Up Author CEG Version 1.0 Status Active DOCUMENT MANAGEMENT REVISION HISTORY Version Date Summary of Changes 1.0 April 2013 This is a new template AUTHORISATION Reviewed by Approved by Date Confirmed Jo Tissier Jo Law April 2013 LATEST FILE NAME Newham City & Hackney Tower Hamlets EMIS Web GLP-1 Initiation and N/A N/A Follow Up CEG N1.0 EMIS LV N/A N/A N/A EMIS PCS N/A N/A N/A INPS(Vision) N/A N/A N/A SUMMARY OF DIFFERENCES BETWEEN BOROUGHS N/A Newham City & Hackney Tower Hamlets Appendices sub-templates, protocols and information screens used by this template EMIS Web EMIS LV EMIS PCS INPS(Vision) Library Items Sub-templates Sub-templates Obesity Monitoring CEG 1.0 Physical Activity CEG 1.0 Alcohol CEG 1.0 Ethnicity CEG 1.0 Smoking Status CEG 1.0 1

2 GLP-1 Initiation & Follow- Up Template Guide (NH) This template includes the coded data entry for quality indicators for initiation and follow-up of GLP-1 therapy in primary care. Prompt Code What does this prompt mean? Section GLP 1 Initiation GLP-1 mimetic treatment EMISNQGL5 Tick Box (prompt for date) initiated Serum glucose level 44f Enter Value Result Fasting glucose level 44f1 Enter Value Result HbA1c (IFCC) 42W5 Enter Value Result 11mmol/mol reduction in HbA1c 6 months after initiation O/E height 229 Enter value Examination O/E weight 22A Enter value Examination Body Mass Index 22K Automatically calculated by EMIS Examination 3% weight reduction 6 months after initiation Trial Injection given Procedure Injection Technique assessed Rotation of injection sites discussed Timing of GLP-1 therapy discussed Titration to maintenance dose of GLP-1 therapy discussed Advice given re cessation if severe abdominal pain GLP-1 therapy storage discussed Sharps disposal discussed Monitoring Advice & Referrals Advised on frequency of blood glucose testing Advice about blood glucose 8CAQ Tick box control Hypoglycaemia advice given (depending on other medication) Reduction of oral hypoglycaemic medication Use of blood glucose meter 2

3 observed DVLA website for up-todate information Advised to inform DVLA 8CA9 Tick Box Foreign Travel Advice 67E Tick Box Advised on diet 8CA4 Tick Box Referred to dietician 8H76 Tick Box Referred to diabetes nurse 8H7f Tick Box Info erview/diabetes%20mellitus.aspx Please proceed to complete all relevant pages on left hand side. 3

4 CEG LIBRARY ITEMS OBESITY MONITORING PAGE Prompt Code What does this prompt mean? Pt advised re wt reducing 8CA40 Yes/No prompt diet Refer to weight 8HHH Yes/No prompt management programme Referred to dietician 8H76 Yes/No prompt PHYSICAL ACTIVITY PAGE Prompt Code What does this prompt mean? Work Activity Work activity Info box Not in employment: e.g. retired, retired for health reasons, unemployed, full-time carer, etc. Spends most time sitting: such as in an office. Spends most time standing or walking: e.g. shop assistant, hairdresser, security guard, childminder, etc. Definite physical effort: e.g. plumber, electrician, carpenter, cleaner, hospital nurse, gardener, postal delivery workers, etc. Vigorous physical effort: e.g. scaffolder, construction worker, refuse collector, etc. Work EMISNQGP2 Not in employment (EMISNQGP2) Spends most time at work sitting (EMISNQGP3) Spends most time at work standing or walking (EMISNQGO4) Work involves definite physical effort (EMISNQGO5) Work involves vigorous physical effort (EMISNQGO6) Hrs spent last wk on housework/childcare Hrs spent last wk gardening / DIY EMISNQGP22 EMISNQGP27 Physical Activity None (EMISNQGP23) Some but less than 1hr (EMISNQGP24) 1hr but less than 3hrs (EMISNQGP25) 3hrs or more (EMISNQGP26) None (EMISNQGP28) Some but less than 1hr (EMISNQGP29) 1hr but less than 3hrs (EMISNQGP30) 3hrs or more (EMISNQGP31) Hrs spent last wk cycling EMISNQGP12 None (EMISNQGP13) Some but less than 1hr (EMISNQGP14) 1hr but less than 3hrs (EMISNQGP15) 3hrs or more (EMISNQGP16) Hrs spent last wk in physical exercise EMISNQGP7 None (EMISNQGP8) Some but less than 1hr (EMISNQGP9) 1hr but less than 3hrs (EMISNQGP10) 3hrs or more (EMISNQGP11) 4

5 Hrs spent last wk walking EMISNQGP17 None (EMISNQGP18) Some but less than 1hr (EMISNQGP19) 1hr but less than 3hrs (EMISNQGP20) 3hrs or more (EMISNQGP21) Walking pace EMISNQGP32 Slow (EMISNQGP33) Steady (EMISNQGP34) Brisk (EMISNQGP35) Fast (EMISNQGP36) Answer all the questions, or score is not valid. Then press button to calculate score GPPAQ index EMISNQGE29 Calculated automatically by EMIS: Inactive (138X) Moderately inactive (138Y) Moderately active (138a) Active (138b) Intervention Brief intervention for 9Oq3 Tick box physical activity Referral for exercise (or referral refusal) 8HHc Referral exercise on prescription 8BAH Referral for exercise programme (8HHc) Declined referral for exercise programme (138S) Referral to health trainer (8HIF) Free text line for type of Ex programme Examination ALCOHOL SCREENING PAGE Screening Alcohol Intake 136 Alcohol intake value in units Assessment AUDIT C /AUDIT Questions Info box The 3 AUDIT C questions are: Q1. How often did you have a drink containing alcohol in the past year? Never 0 pts Monthly or less 1 pts 2 or 4 times a month 2pts 2 to 3 times a week 3 pts 4 or more times a wk 4 pts Assessment Q2. How many standard units did you have on a typical day when you were drinking in the past yr? 1 or 2 0 pts 3 or 4 1 pts 5 or 6 2 pts 7 to 9 3 pts 10 or more 4 pts Q3. How often did you have 6 or more standard units on one occasion in the past year? Never Less than monthly Monthly 5 0 pts 1 pts 2 pts

6 Weekly Daily or almost daily 3 pts 4 pts Add up score and enter below: A positive score for males is 5 or more. A positive score for females is 4 or more. AUDIT C SCORE Drinking within recommended limits: Men 0-4, women 0-3 Hazardous: men 5-7, women 4-7 Harmful: men and women 8+ Audit Questionnaire is Audit C plus the score for the following seven questions: AUDIT C Score 38D4 Value Assessment Assessment Alcohol risk status 136W Intake within recommended limits (136L) Hazardous alcohol use (136S) Harmful alcohol use (136T) 6 Assessment Alcohol advice 8CAM Tick box Alcohol leaflet 8CE1 Tick box given Alcohol Fact Sheet Hyperlink Full Audit Audit Hyperlink Link to full Audit Questionnaire Questionnaire Information on AUDIT Info Box Add up score and enter below Audit Scoring: 0 7 Lower risk, 8 15 Increasing risk, Alcohol use disorders identification test Referral to Community alcohol team Community Alcohol Teams Intervention Higher risk, 20+ Possible dependence 38D3 Value Assessment 8H7p Tick Box Info Box Tower Hamlets Community Alcohol Team: Newham Community Alcohol: Brief intervention 9k1A Tick Box Extended intervention Specialist Alcohol service Referral to specialist alcohol treatment service 9k1B Tick Box Info Box City and Hackney Alcohol Recovery: HkG. Tick Box

7 Under care of 9NN2 Tick box community alcohol team Useful Agencies Info Box A.A Al. Anon Family Groups Web Resources Hyperlink ETHNICITY PAGE Info box Ethnicity Please choose one ethnicity ONLY British or Mixed British Choose from a picking list of codes: 9i0 & 9i00 Other White Choose from a picking list of codes: 9i2% Caribbean Choose from a picking list of codes: 9iB & 9i3 African Choose from a picking list of codes: 9iC, 9i4, 9iFF & 9iFA Other Mixed Choose from a picking list of codes: 9i5, 9i6% Indian or British Indian 9i7 Tick box Pakistani or British Pakistani 9i8 Tick box Bangladeshi or British 9i9 Tick box Bangladeshi Other Asian Choose from a picking list of codes: 9iA% & EMISNQNE35 Other Black Choose from a picking list of codes: 9iD% Chinese 9iE Tick box Other Ethnic Group Choose from a picking list of codes: 9iF% Ethnicity not stated 9iG Tick box Country of origin (Not available in EMIS LV) Choose from a picking list of codes: 13d%, 13h%, 13k%, 13j%, 13g%, 13e%, 13f% Migrant Health Guide Info box Click on the link below to access the Health Protection Agency s Migrant Health Guide. This gives very useful information, country by country, for the health problems we should be aware of, in patients coming from those For EMIS web only countries Migrant Health Guide Hyperlink For EMIS web only Language 7

8 Language 13l (13l %) A picking list of main spoken language Text box for entering in language if person speaks more than one language Interpreter need? 9NU (9NU%) A picking list of interpreter needed for different languages. If language is not listed enter interpreter needed and free text the language required. Interpreter present 9NQ Interpreter present (9NQ0) Interpreter absent (9NQ1) Telephone interpreter (9NQ3) Family member interpreter (EMISNQFA8) Practice member interpreter (EMISNQPR13) Text box for name of interpreter. Language not given 13ZG Tick box. Patient refuses to give language. SMOKING PAGE Smoking Status *Smoking Status Chews Tobacco *Stopped Smoking Cessation ready 137 Never smoked 1371 Ex-smoker 137S Cigarette smoker 137P Rolls own cigarettes 137M Cigar smoker 137J Pipe smoker 137H 137W Tick box 137K Enter date patient stopped smoking, not today s date 137b Ready to stop smoking (137b) Thinking about stopping smoking (137c) Not interested in stopping smoking (137d) Support / Referral *Offer support 8H7i Referral to smoking cessation advisor (8H7i) Referred to stop smoking clinic (8HTK) Declined consent for follow up by smoking cessation team (9Ndg) Pharmacological Treatment * Offer drug therapy 8B2B On NRT (8B2B) Smoking cessation drug therapy declined (8IEM) 8