Dudley Strategy for Tackling Health Inequalities 2010-15

Conclusions:The general conclusions from the analysis of QOF outcomes is that practiceperformance variance is very high and is not explained to a great extent bydeprivation factors. In summary:- There is a high level of under-reporting of prevalence, for all key vasculardiseases/conditions, particularly for hypertension- Deprivation factors are associated with lower prevalence recording for stroke andCHD- There is a great variation in practice performance for all vascular diseaseregisters for all indicators - prevalence recording, exception reporting, clinicaltreatment and control- There are a number of practices that are consistent poor performers.- There are high numbers of patients that are not being treated to optimum levelsfor blood pressure, cholesterol or blood sugar across the CHD, hypertension,stroke, diabetes and CKD registers- Differences in access due to deprivation was not evident in the access totreatment once a patient is on a disease register. This was highlighted by theQOF indicators on exception reporting, blood pressure and lipid measurement,drug prescribing and referral to LRMS.- Deprivation was a factor in relation to differences in outcome of treatment forsome risk factors specifically the control of blood sugar and success at stoppingsmoking. It did not have an impact for the control of blood pressure or lipids.- Low access rates were noted for exercise referral programmes, but access tostop smoking services was high.RecommendationsThe Tackling Inequalities in life expectancy in areas with the worst health anddeprivation (Great Britain. Department of Health, 2010) recommends 3 keyinterventions to provide a cost-effective way of reducing the gap in life expectancy inrelation to CVD:Increase the prescribing of drugs to control blood pressure by 40%Increase the prescribing of drugs to reduce cholesterol by 40%Double the capacity of stop smoking servicesThese have been taken into consideration in the following recommendations whichfocus in 3 areas:Ensuring strategies are in place for risk factor reduction, case-finding and earlydetection of the key vascular diseasesEnsuring that high risk groups can access and use services and achieveequitable treatment outcomesTackling the variation in practice performance and raising the level of overallperformance to ensure more patients are treated to optimum levels. This prioritywill be covered in Section 8.1 on primary care.72