Dudley Strategy for Tackling Health Inequalities 2010-15

Table 4: Range of performance gapDisease/condition registerQOF clinical indicatorPercentagegap rangeDudleyaverageCHD 11 (ACE-I/A2 Antagonist) 0% to 23.1% 10.0% 10.7%Diabetes 15(ACE-I/A2 Antagonist) 0% to 100% 8.3% 10.3%CKD5(ACE-I/ARB) 0% to 100% 13.3% 13.3%Heart Failure 3(ACE-I/ARB) 0% to 20% 7.1% 10.0%CHD10 (Beta blocker) 0% to 46.1% 22.8% 27.5%CHD 9 (aspirin/anti-platelet or anticoagulate)Stroke12 (aspirin/anti-platelet or anticoagulate)AF3 (aspirin/anti-platelet or anticoagulate)Englandaverage0% to 14.5% 5.3% 5.8%0% to 13.5% 4.9% 5.9%0% to 10.6% 5.2% 6.3%Lifestyle Risk Management Service Referrals (LRMS)An important element of chronic disease management and secondary prevention isassessment of the patient‟s lifestyle and referral to LRMS where appropriate.Referral rates/practice were reviewed for physical activity referrals and 4 weeksmoking quitter rates. It was not possible to separate out primary and secondaryprevention referrals.Outcomes for stop smoking services in relation to 4-week quit rates were alsoreviewed to give an indication of the equity of treatment outcomes. Outcomes fromphysical activity referrals are not routinely available.Practice referral rates for physical activity were extremely varied and not related todeprivation. They were also very low across practices ranging from 0 to 16/1,000adult population with a Dudley average of 2.7/1,000. Overall 4 week quit outcomesfor stop smoking were high, ranging from 250 to 721/1,000 referred adult populationwith a Dudley average of 500/1,000. (Figure 9)Practice referral rates for smoking showed a medium positive relationship todeprivation, with practices in deprived areas having higher referral rates. Thismatches need and suggests equitable provision as prevalence of smoking is greaterin areas of higher deprivation. However outcomes across practices were very variedwith practices in deprived areas having lower 4 week quit rates. So although peoplein deprived areas are more likely to be referred, they are less likely to stop smoking.(Figure 10)70