Dudley Strategy for Tackling Health Inequalities 2010-15

Secondary Prevention of CVDOptimum management of the vascular long term conditions within primary care is akey strategy in the reduction of CVD health inequalities. The numbers of peopleliving with a chronic disease are set to rise substantially because our population isgrowing, ageing and lifestyle risk factors such as obesity are becoming morecommon.Health inequalities may result due to deprivation, ethnicity, age, sex and occupation.This section focuses on deprivation as the information is available and deprivationhas been found to be linked with occupation and ethnicity.Health inequalities in relation to the secondary prevention of CVD can occur atdifferent points:- Are people coming forward in the first place? The gap in expected to actualprevalence for the key disease registers gives an indication- Once identified are people accessing treatment?o Are exclusions from the register justifiable? Exception reporting for thedisease registers gives an indicationo Are patients reviewed regularly and their risk factors measured andrecorded? QOF clinical indicators on recording gives an indicationo Are drugs prescribed where indicated? QOF clinical indicators onprescribing gives an indicationo Is there access to supportive services? Referrals to Lifestyle RiskManagement Services (LRMS) gives an indication- Are outcomes from treatment equitable?o Are risk factors controlled to target levels? QOF clinical indicators oncontrol gives an indicationo Are prescribed drugs titrated to optimum levels? Bespoke medicinemanagement audits can give an indicationo Are LRMS outcomes equitable? Outcomes monitoring data from LRMSgives an indicationPrevalence recording of vascular diseases and precursor conditionsThe quality and outcomes framework (QOF) of GP contracts requires GPs to reportthe number of people on the various special disease registers. The actual diseaseprevalence reported from QOF can be compared to expected disease prevalenceestimated from national disease prevalence models. Expected and actualprevalence for the key vascular diseases/conditions for Dudley as a whole is shownin Table 1.Table 1: Expected and Actual Prevalence. Dudley Average.Disease/condition Expected Prevalence Actual PrevalenceCHD 5% 4%Stroke 2% 2%Hypertension 25% 16%Diabetes 6% 5%Source: Doncaster PHIU April 2009 QOF Benchmarking tool64