Heart Failure Management in Primary Care

Transcription

1 Heart Failure Management in Primary Care Going Beyond QOF and implementing NICE Guidance through Enhance HF Kavita Oberoi OBE Founder & Managing Director Oberoi Consulting This session is fully funded by Servier Job Code: UK15HCD0022f Date of Prep: December 2015 ENHANCE HF is provided as a Service to Medicine by Servier

2 Declaration of Interests Funding for Speaking Events has been received from : Novo Nordisk,Bayer, Pfizer, Sanofi, Boehringer-Ingelheim, Astrazeneca, Servier

3 Agenda What does the QOF Data tell us about the gaps the management of heart failure in Primary Care Heart? Impact of HF and LVSD prevalence QOF vs NICE Guidelines the gaps Implementing NICE guidance through Enhance HF

4 QOF Data Year on Year comparison 1 HF and LVSD Prevalence Changes LVSD % HF register 60.00% 2013/ % 0.71% 50.00% 54.20% 53.80% 40.00% 2012/ % 0.71% 30.00% 26.70% 20.00% 2011/ % 0.71% 10.00% 0.00% 0.20% 0.40% 0.60% 0.80% LVSD Prevalence HF Prevalence 0.00% 2011/ / /14 1. QOF Data Tables for 2011/12, 2012/13, 2013/14 available from [last accessed Dec 2015]

5 Implication of change in LVSD Coding 1 Patients Coded with LVSD 250, , , , , ,215 50, / /14 106,613 patients have disappeared from the LVSD lists, and therefore do not move into the HF003 or HF004 indicators for review of therapy 1. QOF Data Tables for 2011/12, 2012/13, 2013/14 available from [last accessed Dec 2015]

6 QOF Indicators for Heart Failure 2 HF003 In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB HF004 In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure Only those patients with both Heart Failure and LVSD codes will be monitored against these indicators /16 General Medical Services (GMS) contract Quality and Outcomes Framework (QOF) Guidance for GMS contract 2015/16

7 QOF Data for HF (England) 2013/14 1 HF003 ACE-I or ARB HF004 ACE-I or ARB and BB 1% 12% 19% 7% 87% 74% Treated Not Treated Exception Reported 92,957 patients qualified for indicator* 972 patients not treated 13,286 patients exception reported Treated Not Treated Exception Reported 68,565 patients qualified for indicator* 5,914 patients not treated 17,862 patients exception reported * Treated no requirement under QOF to optimise therapy 1. QOF Data Tables for 2011/12, 2012/13, 2013/14 available from [last accessed Dec 2015]

8 What Types of Patients Constitute Exception Reporting? HF003 & HF004 3 Persistent Exception Codes (added once): Adverse Reactions and Allergies to therapy (ACEi/ARB and/or Beta Blocker) Expiring Exception Codes (added annually): Therapy contraindicated, declined, not tolerated, not indicated (ACEi/ARB and/or Beta Blocker) If a patient has an exception code to ACEi/ARB, they will automatically be excluded from the QOF indicator for Beta Blocker Therapy (HF004) as well. Therefore patients taking Beta Blocker therapy only do not count towards QOF Achievement 3. QOF Business Ruleset V32 available from [last accessed Dec 2015]

9 How prevalence affects QOF Income 4 Example given for England Statement of Financial Entitlement 2014/15, NHS Employers available from: ment_of_financial_entitlements Amendment Directions_2015_FINAL_V2_2015_03_27.pdf [last accessed Dec 2015]

10 Heart Failure Register Validation 5 The graph below shows the range of prevalences for the HF registers at baseline and after validation across a range or practices The group prevalence increased from 0.79% to 0.94% which equated to 202 patients identified and added to the heart failure registers across the practices. The group LVSD prevalence increased from 0.27% to 0.41% which equates to 172 patients identified and added to the heart failure registers across the practices. 5. Data on file UK14HCD0018(1)

11 QOF Point Value5

12 QOF vs NICE Guidelines The Gaps 6 HF002 Not Included in QOF Not Included in QOF Not Included in QOF 6. Management of LVSD in Primary Care, adapted from NICE Guidelines by Dr Matthew Fay, Westcliffe Cardiology Service and Dr Duncan Petty, Medicine Management Services Bradford District CCG 9 th April 2014

13 QOF vs NICE Guidelines The Gaps HF003 ACE-I commenced but no mention of up titration HF004 Beta Blocker commenced but no mention of up titration Not Included in QOF Not Included in QOF Not Included in QOF Not Included in QOF Not Included in QOF 6. Management of LVSD in Primary Care, adapted from NICE Guidelines by Dr Matthew Fay, Westcliffe Cardiology Service and Dr Duncan Petty, Medicine Management Services Bradford District CCG 9 th April 2014

14 A Solution Enhance HF - A Population Approach in Primary Care ENHANCE HF is provided as a Service to Medicine by Servier

15 Objectives of Enhance HF To assist primary care to implement NICE CCG108 guidelines on the management of Heart Failure To optimise the management of patients with Heart Failure (LVSD) in primary care using evidence based pharmacological treatments in line with ESC guidelines To reduce unnecessary hospital admissions To work towards the delivery of the DOH policies on supporting long term conditions

16 Elements of Enhance HF Intervention by audit, pathway integration and benchmarking to optimise HF

17 Practice Reports Enhance HF Practice Report Data Validation Breakdown by therapy Risk Stratification by BP, Rhythm, Heart Rate Enhance HF High Risk Practice Report Supports triage of patients at highest risk Searches that populate report sit within clinical system Reports support prioritisation of workload and resources

18 Protocol Embedded HF Pathway NICE CG108 7 Integration of HF pathway (based on NICE CG108) as interactive protocol Auto triggers during a consultation & from Status Alert on SystmOne) Can be used to desktop review patients identified by searches Educational Support capture of missing data and improved data quality & QOF 7. NICE Guideline CG108: Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care available at [last accessed Dec 2015]

19 Active system handholding during consultation Alerts are triggered when loading the patient record and are only visible if a patient on the LVSD register has actions that need review i.e. not on optimal therapy for heart failure

20 Summary What does the QOF Data tell us about the gaps the management of heart failure in Primary Care Heart? Impact of HF and LVSD prevalence QOF vs NICE Guidelines the gaps Implementing NICE guidance through Enhance HF