Agenda Item No. 8a SERVICE SPECIFICATION. 1. Introduction:
|
|
- Marilynn Gilmore
- 5 years ago
- Views:
Transcription
1 SERVICE SPECIFICATION Agenda Item No. 8a Service Specification No. Service Atrial Fibrillation Audit patient reviews Commissioner Lead Caroline Davidson Period 1 st September to 31 st March 2017 Date of Review N/A 1. Introduction: 1.1 National/local context and evidence base Stroke is the fourth largest cause of death in the United Kingdom and is the leading cause of disability with 60% of stroke survivors leaving hospital with a disability1. It results in multiple and complex disabilities. The prevalence and burden of stroke is expected to increase in future decades due to the increasingly ageing population and the improvements in hyper-acute care resulting in the increased number of individuals surviving their stroke2. Atrial fibrillation is the most common sustained cardiac rhythm disorder 3 and is a significant risk for stroke. Despite recent guideline updates by NICE with extensive recommendations for anticoagulation management plus quality standards in AF (QS93) i 6 and extending AF QOF indicators for 2015/2016 the management of AF and stroke prevention still remains sub-optimal nationally and across NWL. Therefore in 2017/18 for the second wave of NHS Rightcare programme all 8 CCGs across NWL identified AF and Hypertension as a priority. NHS Operational Planning and Contracting Guidance for also stipulates demand reduction measures include medicines optimisation. AF is a major predisposing factor for stroke and accounts for 20% of all strokes 4, rising to one in three after the age of 80 years 5. Therefore managing AF is key to the prevention of stroke. AF is mostly only detected once a patient presents with serious complications such as stroke or heart failure. Public Health England estimates that over 17,000 people in NW London have undiagnosed AF and it is estimated that 170 AFrelated strokes, and 40 deaths, could be avoided each year through better management, including proactive medication management, earlier diagnosis and informed lifestyle changes. In NW London more than 6,260 people with AF who are at a high risk of having a stroke are not on any anti-coagulation treatment at all. The incidence of AF is age related. The risk of developing AF after the age of 40 is one in four and 30% in people aged over in 4 stroke survivors will experience a recurrent stroke within 5 years 7. Anticoagulation reduces stroke risk in patients with AF 8. NICE Guidance states that 84% of patients diagnosed with AF should be prescribed anticoagulants 9. The risk of stroke for patients not anticoagulated is 5.82%, for those on warfarin the risk is 2.09% and for those on DOACs it is 1.52% 9. Local Context 1) AF not risk assessed - QoF indicator AF006 requires that when patients are diagnosed with AF they should be risk assessed for stroke using the CHADS 2VASc> 2 tool which is done automatically in EMIS once the AF diagnosis is entered in the system. 2,777 patients on the QoF registers require risk assessment and it is estimated that 142 (5%) do not have a CHADS 2VASc> 2 score recorded. Audit tools developed to interrogate practice systems have found that AF diagnoses can be miscoded and therefore these patients are not flagged up for risk assessment and likely not being anticoagulated. A pilot 1
2 run by Metrohealth (refer to appendix 2) using the GRASP AF audit tool found 108 out of a register total of 1,861 patients that had tests or treatment indicating AF were not on the practice AF QoF registers. This represents an increase in the AF register of 6% on average across the 16 practices. Another pilot of 4 practices using the Oberoi ENHANCE SPAF (refer to appendix 3) tool found that 20 (4.5%) patients eligible had not been risk assessed so this indicates that the assumption in the GM modelling is correct. 2) Untreated - The QoF registers show that there are 3,191 patients eligible for anticoagulation of whom 886 (27.8%) are not being treated (including exceptions). 3) Drug therapy not optimized - The GM model indicates that there are 734 patients (30%) inadequately anticoagulated. The Oberoi pilot found 105 (24%) patients who needed their medicines reviewed. Practice variation There is significant variation between practices in the management of AF which cannot be explained practice demographics alone. Prevalence - reported prevalence of AF ranges between 0.2% and 2.24%. CCG prevalence 1.23%. Not Anticoagulated - variation from 80% to 10% QOF exception reporting varies between 0.03% and 65%. There is strong correlation between practices with high exception reporting and number of patients not anticoagulated. 2. Outcomes: 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely X Domain 2 Enhancing quality of life for people with long-term X conditions Domain 3 Helping people to recover from episodes of ill-health or X following injury Domain 4 Ensuring people have a positive experience of care X Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm X 2.2 Local defined outcomes 1. To reduce the risk of stroke and premature death for patients with a diagnosis of AF ie. the avoidance of 64 strokes over 3 years. 2. To comply with NICE Guidelines for the drugs management of AF patients ie. 84% of high risk patients are on anticoagulants and patients who have been prescribed aspirin for AF are switched to anticoagulants. 3. Reduce practice variation in Hillingdon for the management of AF ie. Patients not anticoagulated - variation from 80% to 10% and QOF exception reporting varies between 0.03% and 65% (NICE guidance is max 15.79%). There is strong correlation between practices with high exception reporting and number of patients not anticoagulated. 3. Scope: The Atrial Fibrillation audit is a one off project that will bring practice registers up to date and ensure that AF patients are being medically optimized. Refer to appendix 1 for audit methodology. The audit searches are listed below and the contract only relates to patients highlighted from the searches as requiring review: 2
3 AF resolved Patients taking therapy suggestive of AF but no confirmed diagnosis Patients with coding suggestive of irregular pulse who may be suitable for screening Patients with no CHADS score or CHADS-VAC recorded Male patients CHADS2Vasc score =1 not anticoagulated Patients taking antiplatelet therapy no exception coding Patients with no current therapy or exception coding recorded Patients on anticoagulation that may need their treatment therapy optimised 3.1 Aims and objectives of service The purpose of the project is to find patients that require Risk assessment - ensure that the estimated 142 patients without a CHAD2DS2-VASc score of >2 are risk assessed. Of this cohort it is expected that 120 will be eligible for anticoagulation. Anticoagulation ensure anticoagulation of the 886 patients diagnosed with AF and not being treated and assessment of patients currently anticoagulated that might need review. 3.2 Service description/care pathway 3.3 Population covered The service is available to patients >18 (but mostly >40) with AF who are registered with a GP in Hillingdon. Acceptance criteria Patients who are identified by the audit searches as described in section 3 Scope. 3.5 Exclusion Criteria i. Patients under 18 years of age; ii. Patients registered with a GP outside of Hillingdon; iii. Patients who do not have the conditions explicitly referred to in the acceptance criteria. 3.6 Training, Skills and Experience The Service will be provided by a GP. 3.6 Equipment N/A 3.7 Interdependence with other services/providers The Provider will develop relationships with other providers in order to become an integral member of the Health and Social Care Community. 3
4 Hillingdon Clinical Commissioning Group (CCG); All Hillingdon general practices including GPs, practice nurses and healthcare assistants; networks Blood Pressure units at local acute hospitals; Third sector organisations; Hillingdon Borough Council; Service users as key stakeholders; Healthwatch; 3.8 Finance and Activity Recording Payment will be made for activity which is coded within EMIS using the code below and is subject to the Provider also delivering against the audit outcomes report provided by the CCG Pharmacist. Patients with AF will be coded as G5730 Patients with a Flutter or AF with flutter will be coded as G Service Delivery: The service is delivered by GPs who will review patients on the list provided by the CCG Pharmacist from the searches run in the audit. 1. The practice will allow a CCG specialist pharmacist to review patient records looking at EMIS AF data and compare this with an approved audit tool. 2. The pharmacist will then review existing AF records to establish the list of patients with known AF (including those mis-coded) and not anti-coagulated. Following this appropriate clinical recommendations will be made to the practice 3. Identifying GPs with an interest in this area, and ensuring that they attend CCG provided training on how best to undertake the review and the use of the standard EMIS template that guides the GP through the review as well as providing an audit trail. 4. Coordinating review appointments between eligible patients or their carers and trained GPs. The review consultation will be face to face and last minutes to discuss anti-coagulation therapies. 5. Referring the patient to the appropriate anticoagulation service to have a patient prescribing plan based on the agreed anticoagulant of the patient s choice. 6. The audit cycle will be repeated via the CCG specialist pharmacist as needed to ensure recommendations have been addressed 7. Eligible patients will be those identified by the searches in the audit and patients with a new diagnosis of AF within the time frame of the LIS 8. Working with the CCG to audit the contract in order to assess number of patients seen and with improved management of patients with AF (including anticoagulation) and understand the overall success of the contract. 5. Applicable Service Standards 5.1 Applicable national standards eg NICE, Royal College 4
5 Applicable national standards (eg NICE) 1. National Institute for Health and Care Excellence clinical guideline 180 Atrial fibrillation: the management of atrial fibrillation (2014). 2. Costing Report: atrial fibrillation. Implementing the NICE guideline on atrial fibrillation (CG180). National Institute of Health and Care Excellence (2014). 5.2 Applicable standards set out in Guidance and/or issued by a competent body (eg Royal Colleges) 1. NHS Digital Quality and Outcomes framework (QoF) Search?productid=23378&q=quality+and+outcomes&sort=Relevance&size=10&page=1&area=both#to p 2. National cardiovascular intelligence network Cardiovascular intelligence packs. Public Health England. Accessed October Applicable local standards Please see section 3. Applicable service category Practice(s) delivers their primary medical services contractual and statutory requirements. No unlifted, uncontested, related breaches in the last 12 months. Provider is CQC registered with no conditions, except in circumstances beyond the control of practices, such as the void position resulting from GP retirements; and the management of complaints. General Practice All Locally defined, service-specific requirements for providers Requirement Individuals will have access to relevant and comprehensive information, in the right formats, to inform choice and decision-making about their care. Providers will signpost patients to local services which could help them. Applicable service category All All 5
6 Information and services will be available for individuals who are able to self-manage their conditions or who need care plan support. Providers will consider whether working with other providers would increase the efficacy of the service (e.g. third sector, schools, libraries, religious organisations). Providers will demonstrate that they have identified any potentially hard to reach group (as defined by the JSNA) that exist within their target population, and have taken appropriate action to improve access to the service for these groups. All All All 6. Applicable CQUIN/Quality Goals 5.1 Applicable Quality Requirements (See Schedule 4 Parts [A-D]) The Provider will submit the following quality information to the Commissioner. 7. Key Performance Indicators (KPIs): KPI Areas Baseline Indicative activity plan The patient list for each practice will be provided by the Pharmacist after the AF audit has been run. This is the indicative activity plan for the practice. KP 02 The number of AF patients not previously anticoagulated identified for anticoagulation KPI 03a All patients diagnosed with AF to have CHAD2DS2-VASc risk assessment KPI 03b 142 patients risk assessed and eligible for anticoagulation QoF figures show the number of patients that are expected to be picked up across Hillingdon are: 1. Not risk assessed 142 and eligible for anticoagulation Not anticoagulated 886 and eligible for anticoagulation 620. Breakdown by practice is shown in appendices: appendix 2 patients not risk assessed appendix 3 patients not anticoagulated Activity Reductions Across all of Hillingdon reduction of 64 nonelective admissions for AF related stroke over 3 years. Baseline 16/17 Stroke admissions to HASU = 407 6
7 Year 1 = 12 Years 2 and 3 = 26 Outcome Improvements HCCG PRESCRIBING IN LINE WITH NICE KPI % patients with CHADS2VASc>2 are anticoagulated. KPI % patients eligible for anticoagulation prescribed warfarin KPI % patients eligible for anticoagulation prescribed DOAC NHS Business Services Authority. Medicines Optimisation CCG Dashboard. November 2016 available at s.html 8. Location of Provider Premises: The Service will be provided in the GP practice. All premises and equipment to be used must be subject to proper maintenance, the responsibility for the provision of suitable premises and equipment will be with the provider and must be relevant to the service, including as a minimum: 1. Premises must be DDA compliant; 2. Premises to enable safe and convenient patient access in relation to transport links; 3. Adequate seating to enable all patients to sit while waiting, including chairs for patients who have difficulty sitting low down. 4. WC and handwashing facilities should be provided; 5. Have access to interpretation and translation services; 6. Ensure that all premises and equipment to be used is subject to proper maintenance; 7. Decontamination and clinical waste disposal as appropriate; 8. Non-slip flooring; 9. Storage facilities for consumables. 9. Fee Level and Payment: The Provider will be paid according to the number of patients on their practice list as at 1 st September who are over 40. This is based on the evidence that 1 in 4 over 40s are at risk of developing AF. This is nonrecurrent funding. 7
8 10. Contract and Monitoring Arrangements: End of project comparison against the audit outcomes report provided to the practice by the AF pharmacist. APPENDIX 1 APPENDICES Audit Methodology (outcomes from this provide the practice indicative activity plan). Audit: Medicines Optimisation- Prevention of Stroke and Systemic Embolism in Atrial Fibrillation (AF) Background AF is an important cause of embolic stroke. Anticoagulation is recommended in patients with AF who are at increased stroke risk, unless the benefits of anticoagulation are outweighed by the bleeding risks. Aspirin alone is no longer recommended to reduce the risk of stroke in the AF population (NICE Guideline CG180: Atrial Fibrillation Clinical Guideline 180 June 2014). Key to reducing risk of AF-related stroke is: Early detection of AF in the population. Almost a third of people with AF are undiagnosed and untreated. These patients are at a high risk of premature death and disability Assessing risk of stroke using the CHA 2DS 2-VAS C score. The risk of stroke increases five-fold for people with AF irrespective of symptoms Assessing risk of bleeding risk using the HASBLED score. For most people with AF the benefits of anticoagulation outweigh the risk of bleeding. Initiation of anticoagulant therapies in patients at risk of stroke. Treatment with an oral anticoagulant medication reduces the risk of stroke in someone with AF by two-thirds. Everyone with AF who also has valvular heart disease should be offered anticoagulation- they do not need a formal risk score as stroke risk is high There is an opportunity for medicines optimisation for patients with AF in Hillingdon CCG, with the aim to increase the level of appropriate anticoagulation for patients with AF and improving outcomes for this group of patients. Review steps Four pilot GP practices in Hillingdon will be identified by the CCG to work with a Medicines Management Team (MMT) Pharmacist, with a named GP to lead at each practice. This project will be undertaken at the four GP practices in winter This project plan must be read in conjunction with the: 1. Hillingdon Cardiology Clinical Working Group AF guideline (Annex 1) 8
9 2. Hillingdon CCG guideline: Direct Oral Anticoagulants (DOACs) for the Prevention of Stroke and Systemic Embolism in Non-Valvular Atrial Fibrillation (NVAF) (Appendix 2) Objectives Validate the AF register Assess patients with AF, paroxysmal AF and atrial flutter for anticoagulation Optimise anticoagulation therapy to ensure maximum reduction in stroke risk with minimum risk of bleeding 1. Validating the AF Register Following application of the Enhance SPAF tool the following search groups will be categorised: o Patients with AF resolved recorded o Patients with codes specifically related to AF QQF indicators, with no confirmed AF diagnosis o Patients taking therapy suggestive of AF, with no confirmed AF diagnosis on EMISS WEB o Patients with coding suggestive of AF, with no confirmed AF diagnosis The MMT Pharmacist will check the notes of all patients identified in the categories above with possible missing diagnosis of AF Patients with AF will be coded as G5730 Patients with a Flutter or AF with flutter will be coded as G573 A comparison of the number of patients coded as AF for each practice will be made against the prevalence of patients identified as AF by the MMT Pharmacist 2. Assessing Patients with AF, Paroxysmal AF and Atrial Flutter for Anticoagulation When the AF registration has been validated, AF diagnosis confirmed and the AF read code added where appropriate, the search will be re-run to ensure all AF patients are included The re-running of the Enhance SPAF tool will identify the following patients: o On AF register and on warfarin in the last 6 months with INR uncontrolled recorded or INR values out of range o On AF register and on antiplatelet only in the last 6 months with CHA 2DS 2-VAS C 2 o On AF register and exception coded to warfarin excluding patients previously on a DOAC or not indicated for warfarin o On AF register and requires CHA 2DS 2-VAS C score and HASBLED score Following the search a comparative description of anticoagulation/ antiplatelet medication regimes across the 4 practices will be recorded. The different regimes will be denominated to: o Warfarin alone o DOAC alone o Single antiplatelet o Dual antiplatelet o Single antiplatelet and anticoagulation o Triple therapy- 2 antiplatelets and an anticoagulant o Nil 3. Optimising Anticoagulation Therapy to Ensure Maximum Reduction in Stroke Risk with Minimum Risk of Bleeding 3a MMT Pharmacist Review All patients on the practice AF register will be reviewed by the MMT Pharmacist in March Patients will be split into the following categories: 9
10 Patient group AF patients already prescribed warfarin alone AF patients already prescribed a DOAC alone AF patients prescribed no anticoagulation or antiplatelet treatment AF patients prescribed antiplatelet treatment alone AF patients prescribed combined anticoagulation and antiplatelet treatment Comment Is this the correct decision for the patient? Is warfarin control adequate has time in therapeutic range been assessed? Is this the correct decision for the patient? Is the dosage prescribed in line with manufacturers recommendations? All patients to be reviewed All patients to be reviewed Check if patients are taking antiplatelet treatment for other indications e.g. myocardial infarction All patients to be reviewed Check if patients are taking antiplatelet treatment for other indications e.g. myocardial infarction For patients with AF, paroxysmal AF and atrial flutter not prescribed any oral anticoagulant an assessment of the individual patient s stroke risk and bleeding risk will be assessed using the CHA 2DS 2-VAS C and HASBLED scores. A breakdown of the current anticoagulation/ antiplatelet medication regimes and the number of patients for GP review following the analysis of patients by the MMT Pharmacist is required to show a comparison between the respective GP Practices. The MMT Pharmacist will: o o o o o Consider anticoagulation for men with a CHA 2DS 2-VASc score of 1 and offer anticoagulation to people with a CHA 2DS 2-VASc score of 2 or above, taking bleeding risk into account Review need for anticoagulation and the quality of anticoagulation for people who are taking an anticoagulant Review the anticoagulation control in people taking vitamin K antagonists (warfarin) Review patients prescribed a DOAC whether the dosage is appropriate against clinical parameters such as renal function, manufacturers recommendations (according to weight and age), and concurrent drug therapy. A renal function check will be recommended if a recent result (as a minimum within last 12 months) is not available. Assess patients currently prescribed antiplatelet therapy for preventing AF related strokes (not for other indications). In the past, aspirin had been considered an alternative to anticoagulant therapy in AF patients unable to take warfarin, however it is substantially less effective than anticoagulation. Combination antiplatelet therapy, aspirin with clopidogrel, is more effective for preventing AF related strokes than aspirin alone, but is still less effective than oral anticoagulation, and associated with a bleeding risk similar to that of anticoagulation. Combination antiplatelet therapy is not routinely recommended for preventing AF related strokes (Specialist Pharmacy Service: Medicines Optimisation in Atrial Fibrillation the first stop for professional advice). The MMT Pharmacist will give their comments and recommendations to the named GP by 31 st March 2017 Data relevant to the GP including weight, renal function, other relevant medication or medical history that could affect the choice of anticoagulation will be provided. 10
11 3b GP Review The named GP at the respective practices will co-ordinate a practice review of the recommendations made by the MMT Pharmacist. The MMT Pharmacist would further help facilitate the named GP with reviewing patients if requested. Where they consider appropriate, the GP practice will implement changes suggested by the MMT Pharmacist to improve the uptake and safety of anticoagulation in their AF patients. The named GP will feedback final outcomes and implementations by 14 th April The status of GP reviews at 14 th April 2017 will be described. The choice of anticoagulation will be left to the GP to discuss with the patient using the NICE Patient Decision Aid and will be based on patient clinical features (e.g. significant renal impairment, drug interactions or extremes of bodyweight) and preferences. Anticoagulation may be with apixaban, dabigatran, edoxaban, rivaroxaban or warfarin, dependent licensed indication. Dual (single antiplatelet + anticoagulation) or Triple (dual antiplatelet therapy + anticoagulation) therapy: For all patients on dual or triple therapy a rationale and duration should be clearly documented. If continuing dual or single antiplatelet therapy with anticoagulation beyond 1 year this should be confirmed with a cardiologist (Specialist Pharmacy Service: Medicines Optimisation in Atrial Fibrillation the first stop for professional advice The most common indication for dual antiplatelet therapy + anticoagulation will be patients with atrial fibrillation/ flutter who have undergone coronary artery stenting. In all cases rationale and duration of treatment the use for triple therapy must be defined by a cardiologist and should be aspirin + clopidogrel (and not ticagrelor or prasugrel) + anticoagulation. 11
12 APPENDIX 2 BASELINE DATA FROM QoF - PATIENTS REQUIRING RISK ASSESSMENTS Practice code Practice name Number of patients not risk assessed Exceptions Possible no of reviews
13
14 APPENDIX 3 BASELINE DATA FROM QoF - PATIENTS POSSIBLY ELIGIBLE FOR ANTICOAGULATION Practice code Practice name Number of patients not anticoagulated Exceptions Possible no of reviews
15
Atrial Fibrillation Implementation challenges. Lesley Edgar Ross Maconachie
Atrial Fibrillation Implementation challenges Lesley Edgar Ross Maconachie Atrial Fibrillation Most common heart rhythm disturbance Rapid and irregular electrical signals Reduced efficiency of blood flow
More informationQuestion 1: Between 1 July 2014 and 30 June 2015, in the area covered by your CCG:
Atrial Fibrillation in Your Area Question 1: Between 1 July 2014 and 30 June 2015, in the area covered by your CCG: a) What was the prevalence of atrial fibrillation (AF)? 6636 (as of 22/10/2015) 2.1%
More informationrequesting information regarding atrial fibrillation in NHS Ashford Clinical Commissioning Group
October 2015 Our Ref: FOI.15.ASH0149 requesting information regarding atrial fibrillation in NHS Ashford Clinical Commissioning Group Original Request Survey attached. Question 1: Between 1 July 2014 and
More informationSCHEDULE 2 THE SERVICES
SCHEDULE 2 THE SERVICES A. Service Specifications Mandatory headings 1 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination
More informationCosting Report: atrial fibrillation Implementing the NICE guideline on atrial fibrillation (CG180)
Putting NICE guidance into practice Costing Report: atrial fibrillation Implementing the NICE guideline on atrial fibrillation (CG180) Published: June 2014 This costing report accompanies the clinical
More informationAHSN Business Case User Guide: Improving AF Identification and Optimising Management to Prevent AF-Related Stroke. Version: 13 March 2017
AHSN Business Case User Guide: Improving AF Identification and Optimising Management to Prevent AF-Related Stroke Version: 13 March 2017 Introduction This business case template has been created so that
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Single Technology Appraisal (STA)
Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation Thank you for agreeing to give us a statement on your organisation s view of the technology and the way
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Myocardial infarction: secondary prevention in primary and secondary care for patients following a myocardial infarction 1.1
More informationpat hways Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16
pat hways Anticoagulants, including non-vitamin K antagonist oral anticoagulants (NOACs) Key therapeutic topic Published: 26 February 2016 nice.org.uk/guidance/ktt16 Options for local implementation NICE
More informationHERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised
Name: generic (trade) Dabigatran etexilate (Pradaxa ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) DABIGATRAN RECOMMENDED What it is Indications Date decision last revised Direct thrombin inhibitor
More informationTackling atrial fibrillation the health economics evidence
Tackling atrial fibrillation the health economics evidence Professor Gary Ford,CBE Chief Executive Officer, Oxford Academic Health Science Network Consultant Stroke Physician, Oxford University Hospitals
More information2 Summary of NICE TA 249: Atrial fibrillation - Dabigatran Etexilate
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals NICE TA 249: Atrial fibrillation - Dabigatran Etexilate 1 Name of Commissioning Team Long Term Conditions Commissioning Team
More informationSCHEDULE 2 THE SERVICES. A. Service Specifications
SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification No. 04/MSKT/0013 Service PAN DORSET FRACTURE LIAISON SERVICE Commissioner Lead CCP for Musculoskeletal & Trauma Provider Lead Deputy
More informationADDRESSING UNMET NEEDS IN MANAGING AF ACROSS THE GLOBE
ADDRESSING UNMET NEEDS IN MANAGING AF ACROSS THE GLOBE HELEN WILLIAMS FFRPS, MRPHARMS, PGDIP (CARDIOL) IPRESC CONSULTANT PHARMACIST FOR CVD, SOUTH LONDON CLINICAL LEAD FOR ATRIAL FIBRILLATION, HEALTH INNOVATION
More informationThat the Single Commissioning Board supports the project outlined in this report and proceeds as described.
Report to: SINGLE COMMISSIONING BOARD Date: 26 September 2017 Officer of Single Commissioning Board Subject: Report Summary: Recommendations: Jessica Williams Interim Director of Commissioning ATRIAL FIBRILLATION
More informationCosting statement: Atrial fibrillation and heart valve disease: selfmonitoring coagulation status using point-of-care coagulometers (the CoaguChek XS)
Putting NICE guidance into practice Costing statement: Atrial fibrillation and heart valve disease: selfmonitoring coagulation status using point-of-care coagulometers (the CoaguChek XS) Published: September
More informationRhona Maclean
An early evaluation of the impact of the North Trent policy regarding the use of Non-Vitamin K antagonists for SPAF in a secondary care anticoagulation clinic Rhona Maclean Rhona.maclean@sth.nhs.uk Risk
More informationCommissioning for value focus pack
Commissioning for value focus pack Clinical commissioning group: NHS MILTON KEYNES CCG Focus area: Cardiovascular disease (CVD) pathway Version 2 June 2014 Contents 1. Background and context About the
More informationGOVERNING BODY REPORT
GOVERNING BODY REPORT DATE OF MEETING: 20th September 2012 TITLE OF REPORT: KEY MESSAGES: NHS West Cheshire Clinical Commissioning Group has identified heart disease as one of its six strategic clinical
More informationNHS Lanarkshire Guidance on Anticoagulant treatment for patients with non-valvular atrial fibrillation
1 NHS Lanarkshire Guidance on Anticoagulant treatment for patients with non-valvular atrial fibrillation Atrial fibrillation (AF) affects about 1.2% of the population in the United Kingdom and accounts
More informationSCHEDULE 2 THE SERVICES
04e SCHEDULE 2 THE SERVICES A. Service Specifications This is a non-mandatory model template for local population. Commissioners may retain the structure below, or may determine their own in accordance
More informationAtrial Fibrillation. A guide for Southwark General Practice. Key Messages. Always work within your knowledge and competency
Atrial Fibrillation A guide for Southwark General Practice Key Messages 1. Routinely offer pulse checks to patients at high risk of AF 2. Use the CHA 2 DS 2 VASc score to identify patients for anticoagulation
More informationAtrial fibrillation and anticoagulation therapy
Atrial fibrillation and anticoagulation therapy This leaflet offers more information about atrial fibrillation for patients who have been advised that they need anticoagulation therapy. If you have any
More informationPOTENTIAL LINKAGES BETWEEN THE QUALITY AND OUTCOMES FRAMEWORK (QOF) AND THE NHS HEALTH CHECK
POTENTIAL LINKAGES BETWEEN THE QUALITY AND OUTCOMES FRAMEWORK (QOF) AND THE NHS HEALTH CHECK Author: CHARLOTTE SIMPSON, SPECIALTY REGISTAR PUBLIC HEALTH (ST3), CHESHIRE EAST COUNCIL/MERSEY DEANERY SUMMARY
More informationPRESENTATION TITLE. Case Studies
PRESENTATION TITLE Case Studies 1) SH is a 67 year old male. He has a history of type 2 diabetes, controlled hypertension and peripheral artery disease. He takes naproxen 500mg bd for arthritis and admits
More informationCommunity alcohol detoxification in primary care
Community alcohol detoxification in primary care 1. Purpose The purpose of this primary care enhanced service is to improve the health and quality of life of people whose health may be compromised by their
More informationWORKING DOCUMENT Version 5 DRAFT LOCAL ENHANCED SERVICE SPECIFICATION Palliative Care
Appendix F WORKING DOCUMENT Version 5 DRAFT LOCAL ENHANCED SERVICE SPECIFICATION Palliative Care Introduction 1. The LES has been introduced to embed good clinical practice and effective performance management
More informationStandard Operating Procedure: Early Intervention in Psychosis Access Times
Corporate Standard Operating Procedure: Early Intervention in Psychosis Access Times Document Control Summary Status: New Version: V1.0 Date: Author/Owner: Rob Abell, Senior Performance Development Manager
More informationPrimary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion. Greg Francisco, MD, FACC
Primary Care Atrial Fibrillation Update: Anticoagulation and Left Atrial Appendage Occlusion Greg Francisco, MD, FACC DISCLOSURES None to declare Estimated 33.5million have AF worldwide (6-7million in
More informationDorset Health and Wellbeing Board
Dorset Health and Wellbeing Board Date of Meeting 09 November 2016 Subject of Report Sustainability and Transformation Plan Refresh Update Report Author Partner Organisation Tim Goodson, Chief Officer,
More informationCQC Insight. NHS GP practices Indicators and methodology
CQC Insight NHS GP practices s and methodology June 2017 Contents Introduction... 3 Background information on CQC Insight reports... 4 Displaying proportions as percentages... 5 Suppression rules... 5
More informationTrends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation,
Trends and Variation in Oral Anticoagulant Choice in Patients with Atrial Fibrillation, 2010-2017 Junya Zhu, PhD Department of Health Policy and Management January 23, 2018 Acknowledgments Co-Authors G.
More informationCosting report: Lipid modification Implementing the NICE guideline on lipid modification (CG181)
Putting NICE guidance into practice Costing report: Lipid modification Implementing the NICE guideline on lipid modification (CG181) Published: July 2014 This costing report accompanies Lipid modification:
More information18/09/2012. Dr. Khalid Khan Consultant Cardiologist BCUHB. Oral Anticoagulation Update Day 12 th September 2012 University of Birmingham
Dr. Khalid Khan Consultant Cardiologist BCUHB Oral Anticoagulation Update Day 12 th September 2012 University of Birmingham 1 NICE vs. Local Guidance NICE says no We say no NICE says yes We say no NOACs
More informationAlison Tennant MRPharmS MPH Head of Service Improvement and Quality Dudley CCG
Alison Tennant MRPharmS MPH Head of Service Improvement and Quality Dudley CCG Commissioning is the set of linked activities required to assess the healthcare needs of a population, specify the services
More informationEdoxaban Switch Programme - Frequently Asked Questions
Edoxaban Switch Programme - Frequently Asked Questions What should I tell patients? NHS Tayside is reviewing all patients currently receiving a Direct Oral Anticoagulant (DOAC) for stroke prevention in
More informationProof of Concept: NHS Wales Atlas of Variation for Cardiovascular Disease. Produced on behalf of NHS Wales and Welsh Government
Proof of Concept: NHS Wales Atlas of Variation for Cardiovascular Disease Produced on behalf of NHS Wales and Welsh Government April 2018 Table of Contents Introduction... 3 Variation in health services...
More informationCommissioning for Better Outcomes in COPD
Commissioning for Better Outcomes in COPD Dr Matt Kearney Primary Care & Public Health Advisor Respiratory Programme, Department of Health General Practitioner, Runcorn November 2011 What are the Commissioning
More informationAfib, Stroke, and DOAC. Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS
Afib, Stroke, and DOAC Albert Luo, MD. Cardiology Lindsey Frischmann, DO. Neurology Xiao Cai, MD. HBS Disclosure of Relevant Financial Relationships I have no relevant financial relationships with commercial
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS F INDIVIDUAL MEASURES: REGISTRY
More informationApixaban for stroke prevention in atrial fibrillation. August 2010
Apixaban for stroke prevention in atrial fibrillation August 2010 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to
More informationOptimising detection and stroke prevention strategies in patients with Atrial Fibrillation in West Hampshire
Optimising detection and stroke prevention strategies in patients with Atrial Fibrillation in West Hampshire Dr Chris Arden GP, Chandlers Ford GPSI Cardiology, Southampton West Hampshire CCG Cardiovascular
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process
Quality ID #326 (NQF 1525): Atrial Fibrillation and Atrial Flutter: Chronic Anticoagulation Therapy National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area: Management of Chronic
More informationTRIPLE THERAPY, NOACs with concurrent indication for DAPT. Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust
TRIPLE THERAPY, NOACs with concurrent indication for DAPT Paul Wright Lead Cardiac Pharmacist The Heart, UCLH NHS Foundation Trust Content Why consider triple therapy What we know of triple therapy Current
More informationANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION
ANTI-THROMBOTIC THERAPY in NON-VALVULAR ATRIAL FIBRILLATION Colin Edwards Auckland Heart Group Waitemata Health June 2015 PFIZER Lecture series Disclosures EPIDEMIOLOGY Atrial fibrillation is the most
More information2. Quality and Outcomes Framework: new NICE recommendations
Proposed Changes to the GMS Contract 2013/14 1. GP pay and expenses uplift It is proposed GP pay and expenses is uplifted by 1.5%. This increased investment will allow for an average pay increase of up
More informationSCHEDULE 2 THE SERVICES. A. Service Specifications
SCHEDULE 2 THE SERVICES A. Service Specifications Service Specification 11J/0232 No. Service Enhanced Frailty Service (Christchurch MP and Farmhouse Surgery) Commissioner Lead Primary Care Team Provider
More informationGRASP-AF- The National Picture. Dr Richard Healicon National Improvement Lead Ian Robson Senior Analyst NHS Improvement February 2012
GRASP-AF- The National Picture Dr Richard Healicon National Improvement Lead Ian Robson Senior Analyst NHS Improvement February 2012 Outline AF and stroke Objective Management of stroke risk Stroke risk
More informationInitial assessment of patient with AF in primary care DR BRUCE TAYLOR GPwSI Cardiology SCN Merseyside and Cheshire Clinical Lead Primary care
Initial assessment of patient with AF in primary care DR BRUCE TAYLOR GPwSI Cardiology SCN Merseyside and Cheshire Clinical Lead Primary care 11 th and 25 th September 2014 3 KEY OBJECTIVES OF TALK 1.
More informationNICE offer to STPs: CVD prevention
NICE offer to STPs: CVD prevention Zoe Girdis Regional Technical Adviser South of England and Channel Islands NICE support for STPs Based on the best available evidence of what works and is costeffective,
More informationPrevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation
Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation Consensus Statement ~ October 2011 Contents 1 About 3 2 Introduction 5 3 Development of the consensus
More informationSouthern Trust Anticoagulant Team
CLINICAL GUIDELINES ID TAG Title: Author: Speciality / Division: Directorate: Anticoagulation- Primary Care Guidance for reviewing patients on DOACs Southern Trust Anticoagulant Team Haematology Acute
More informationNorth Wales Cardiac Network Guidelines on oral antiplatelet therapy in cardiovascular disease
Guidelines on oral antiplatelet therapy in cardiovascular disease This guidance should be considered as one part of the wider therapeutic management of patients. The indication for antiplatelet therapy
More informationPRIMARY CARE CO-COMMISSIONING COMMITTEE 8 SEPTEMBER 2015
Part 1 Part 2 PRIMARY CARE CO-COMMISSIONING COMMITTEE 8 SEPTEMBER 2015 Title of Report Trafford Palliative care Quality Premium Scheme 2015/16 Purpose of the Report The purpose of the report is to detail
More informationNATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE General practice Indicators for the NICE menu
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE General practice Indicators for the NICE menu Indicator area: Pulse rhythm assessment for AF Indicator: NM146 Date: June 2017 Introduction There is evidence
More informationTo approve Primary Care Commissioning Committees in Common Date: 9/11/18. NWS CCG 58 Church St, Weybridge, Surrey, KT13 8DP
Agenda item: 9 Paper no: PCCC ic 31-18 Title of Report: Status: Committee: Attention Deficit Hyperactivity Disorder (ADHD) in children 6-17 years old - 12 monthly review monitoring for CNS stimulants,
More informationResults from RE-LY and RELY-ABLE
Results from RE-LY and RELY-ABLE Assessment of the safety and efficacy of dabigatran etexilate (Pradaxa ) in longterm stroke prevention EXECUTIVE SUMMARY Dabigatran etexilate (Pradaxa ) has shown a consistent
More informationEliquis and plavix combination therapy
Eliquis and plavix combination therapy ELIQUIS Dosing for Patients With NVAF. patients treated with aspirin or the combination of bleeding or completion of a course of therapy,. 9-11-2011 Thrombosis is
More informationAppendix 1. Cognitive Impairment and Dementia Service Elm Lodge 4a Marley Close Greenford Middlesex UB6 9UG
Appendix 1 Mr Dwight McKenzie Scrutiny Review Officer Legal and Democratic Services Ealing Council Perceval House 14 16 Uxbridge Road Ealing London W5 2HL Cognitive Impairment and Dementia Service Elm
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE SCOPE. Clinical guideline for the management of atrial fibrillation
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE 1 Guideline title SCOPE Clinical guideline for the management of atrial fibrillation 1.1 Short title Atrial fibrillation 2 Background a) The National Institute
More informationThe first stop for professional medicines advice. Community Pharmacy Oral Anticoagulant Safety Audit
Community Pharmacy Oral Anticoagulant Safety Audit This audit has been developed with help and support from the following organisations: Community Pharmacy Patient Safety Group PharmOutcomes Pharmaceutical
More informationFINANCE COMMITTEE DEMOGRAPHIC CHANGE AND AGEING POPULATION INQUIRY SUBMISSION FROM NATIONAL OSTEOPOROSIS SOCIETY
FINANCE COMMITTEE DEMOGRAPHIC CHANGE AND AGEING POPULATION INQUIRY SUBMISSION FROM NATIONAL OSTEOPOROSIS SOCIETY What is your view of the effects of the demographic change and an ageing population on the
More informationNational Institute for Health and Clinical Excellence. Single Technology Appraisal (STA)
National Institute for Health and Clinical Excellence Comment 1: the draft remit Single Technology Appraisal (STA) Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial Response
More informationQOF indicator area: Chronic Obstructive Pulmonary disease (COPD)
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Cost impact statement: Chronic Obstructive Pulmonary Disease QOF indicator area:
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Peripheral arterial disease Potential output:
More informationCase Study. A Campaign to Raise Awareness of Atrial Fibrillation (AF) in Lancashire. June 2015.
Case Study A Campaign to Raise Awareness of Atrial Fibrillation (AF) in Lancashire. June 2015. North West Coast Academic Health Science Network AF/Stroke Prevention Programme Academic Health Science Networks
More informationGuideline scope Hypertension in adults (update)
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Hypertension in adults (update) This guideline will update the NICE guideline on hypertension in adults (CG127). The guideline will be
More informationEnhanced Service Specification. Childhood seasonal influenza vaccination programme 2017/18
Enhanced Service Specification Childhood seasonal influenza vaccination programme 2017/18 2 Enhanced Service Specification Childhood seasonal influenza vaccination programme Version number: 1 First published:
More informationThe Challenge. Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Anticoagulation/Stroke
Anticoagulation/Stroke Warfarin v new oral anticoagulants post PCI Warfarin or Novel Oral Anti-Coagulants in the PCI patient? Gerry Devlin Chairs: Phillip Matsis & Tony Scott Gerry Devlin Honorary Associate
More informationPRIMARY CARE CO-COMMISSIONING COMMITTEE 18 March 2016
Part 1 Part 2 PRIMARY CARE CO-COMMISSIONING COMMITTEE 18 March 2016 Title of Report Supporting deaf patients to access primary care services Purpose of the Report The report is to provide the co-commissioning
More informationOptimising detection and stroke prevention strategies in patients with Atrial Fibrillation in West Hampshire
Optimising detection and stroke prevention strategies in patients with Atrial Fibrillation in West Hampshire Dr Chris Arden GP, Chandlers Ford GPSI Cardiology, Southampton West Hampshire CCG Cardiovascular
More informationA10/S(HSS)/a. Heart Transplantation Service (adults)
A. Service Specifications SCHEDULE 2 THE SERVICES Service Specification No. Service A10/S(HSS)/a Heart Transplantation Service (adults) Commissioner Lead Provider Lead Period Date of Review 1. Population
More informationLincolnshire JSNA: Stroke
Lincolnshire JSNA: Stroke What do we know? Summary Around 2% of the population in Lincolnshire live with the consequences of this disease (14, 280 people) in 2010 Over 1,200 people were admitted for stroke
More informationACE Programme SOMERSET INTEGRATED LUNG CANCER PATHWAY. Phases One and Two Final Report
ACE Programme SOMERSET INTEGRATED LUNG CANCER PATHWAY Phases One and Two Final Report July 2017 Introduction This paper presents the learning and actions that have been generated from phase One and Two
More informationNikki Mallinder on behalf of Linda Honey. Karen Thorburn Date: 04/10/18
Agenda item: 7 ii Paper no: PCCC ic 20-18 Title of Report: Status: Committee: Venue: Update to the Attention Deficit Hyperactivity Disorder (ADHD) in Childhood) 12 monthly physical medication monitoring
More informationDo Not Cite. Draft for Work Group Review.
Defect Free Acute Inpatient Ischemic Stroke Measure Bundle Measure Description Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke OR transient ischemic attack who were admitted
More informationAtrial fibrillation. Understanding NICE guidance
Understanding NICE guidance Information for people who use NHS services Atrial fibrillation NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases and the treatments
More informationEnhanced Service Specification. Childhood seasonal influenza vaccination programme 2018/19
Enhanced Service Specification Childhood seasonal influenza vaccination programme 2018/19 Contents Childhood seasonal influenza vaccination programme... 1 Contents... 4 1 Introduction... 5 2 Background...
More informationDementia Strategy MICB4336
Dementia Strategy 2013-2018 MICB4336 Executive summary The purpose of this document is to set out South Tees Hospitals Foundation Trust s five year strategy for improving care and experience for people
More informationThe Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure?
The Poor Long-Term Candidate for Warfarin: NOAC or Left Atrial Appendage Closure? Suneet Mittal, MD, FACC, FHRS Director, Electrophysiology Laboratory Valley Health System Ridgewood, NJ and New York, NY
More informationAtrial Fibrillation Collaborative. Thursday 7 May 2015
Atrial Fibrillation Collaborative Thursday 7 May 2015 Welcome and introductions Peter Carpenter KSS AHSN Nicky Jonas SEC CVD SCN AF Project Support KSS Academic Health Science Network & South East Cardiovascular
More informationDraft Falls Prevention Strategy
Cheshire West & Chester Council Draft Falls Prevention Strategy 2017-2020 Visit: cheshirewestandchester.gov.uk Visit: cheshirewestandchester.gov.uk 02 Cheshire West and Chester Council Draft Falls Prevention
More informationPutting NICE guidance into practice. Resource impact report: Hearing loss in adults: assessment and management (NG98)
Putting NICE guidance into practice Resource impact report: Hearing loss in adults: assessment and management (NG98) Published: June 2018 Summary This report focuses on the recommendation from NICE s guideline
More informationNHS Sheffield Community Pharmacy Seasonal Flu Vaccination Programme for hard to reach at risk groups (and catch up campaign for over 65s)
NHS Sheffield Community Pharmacy Seasonal Flu Vaccination Programme for hard to reach at risk groups 2012-13 (and catch up campaign for over 65s) Service Evaluation! Supported by Sheffield!Local!Pharmaceutical!Committee!
More informationPage 1. Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion. Atrial fibrillation: Scope of the problem
Current Trends in the Management of Atrial Fibrillation: Left Atrial Appendage Occlusion Benjamin A. D Souza, MD, FACC, FHRS Assistant Professor of Clinical Medicine Penn Presbyterian Medical Center Cardiac
More informationStroke secondary prevention. Gill Cluckie Stroke Nurse Consultant St. George s Hospital
Stroke secondary prevention Gill Cluckie Stroke Nurse Consultant St. George s Hospital Stroke recurrence The risk of recurrent stroke is greatest after first stroke 2 3% of survivors of a first stroke
More informationAnti-thromboticthrombotic drugs
Atrial Fibrillation 2011: Anticoagulation strategies and clinical outcomes Panos E. Vardas President Elect of the ESC, Prof. of Cardiology, University Hospital of Crete Clinical outcomes affected by AF
More informationAsif Serajian DO FACC FSCAI
Anticoagulation and Antiplatelet update: A case based approach Asif Serajian DO FACC FSCAI No disclosures relevant to this talk Objectives 1. Discuss the indication for antiplatelet therapy for cardiac
More informationArrhythmia Care in the DGH What Still Needs to be Done? Dr. Sundeep Puri Consultant Cardiologist
Arrhythmia Care in the DGH What Still Needs to be Done? Dr. Sundeep Puri Consultant Cardiologist LOTS!!! This presentation confines itself to the situation in the North West. The views expressed are my
More informationUpdates in Stroke Management. Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy
Updates in Stroke Management Jessica A Starr, PharmD, FCCP, BCPS Associate Clinical Professor Auburn University Harrison School of Pharmacy Disclosure I have no actual or potential conflict of interest
More information14/15 Threshold 15/16 Points 15/16. Points. Retired Replaced by NM82/AF007. Replacement NO CHANGE
SUMMARY OF CHANGES TO QOF 2015/1 - ENGLAND KEY No change Retired/replaced Wording and/or change Point or threshold change Indicator ID change 14/15 QOF ID 15/1 QOF ID NICE ID Indicator wording Changes
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE QUALITY AND OUTCOMES FRAMEWORK (QOF) INDICATOR DEVELOPMENT PROGRAMME Briefing paper QOF indicator area: Primary prevention of CVD Potential output:
More informationGP Insight Report. The Family Practice CQC ID:
GP Insight Report The Family Practice CQC ID: 1-562698152 1 CQC GP Insight Report February 2017 spacer Practice background > Introduction INTRODUCTION CONTEXTUAL INFORMATION This report details the CQC
More informationNHS Sheffield Community Pharmacy Catch Up Seasonal Flu Vaccination Programme for hard to reach at risk groups
NHS Sheffield Community Pharmacy Catch Up Seasonal Flu Vaccination Programme for hard to reach at risk groups 2011-12 Service Evaluation Supported by Sheffield Local Pharmaceutical Committee Supporting
More informationSCHEDULE 2 THE SERVICES
1 SCHEDULE 2 THE SERVICES A. Service Specifications Mandatory headings 1 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination
More informationEvaluate Risk of Stroke & Bleeding in AF Patients
XV World Congress of Arrhythmias, Beijing, China - 17-20 September, 2015 Evaluate Risk of Stroke & Bleeding in AF Patients Antonio Raviele, MD, FESC, FHRS President ALFA Alliance to Fight Atrial fibrillation
More informationIndividual Therapeutic Selection Of Anti-coagulants And Periprocedural. Miguel Valderrábano, MD
Individual Therapeutic Selection Of Anti-coagulants And Periprocedural Management Miguel Valderrábano, MD Outline Does the patient need anticoagulation? Review of clinical evidence for each anticoagulant
More informationGetting Serious About CVD Prevention What does this mean for Primary Care?
Getting Serious About CVD Prevention What does this mean for Primary Care? Dr Matt Kearney GP and National Clinical Director for Cardiovascular Disease Prevention NHS England and Public Health England
More informationCamden Clinical Commissioning Group
Locally Commissioned Service Clinical Lead Commissioner Reporting Mechanism/Frequency Payment Frequency Payment Contact Childhood Immunisation Dr Oliver Anglin Camden Clinical Commissioning Group Partially
More informationDIRECT ORAL ANTICOAGULANTS
2017 Cardiovascular Symposium DIRECT ORAL ANTICOAGULANTS ERNESTO UMAÑA, MD, FACC ORAL ANTICOAGULANTS Vitamin K Antagonists (VKAs): Warfarin Non Vitamin K Antagonists Direct oral anticoagulants Novel Oral
More information