Anticipatory care Prevention & management of chronic disease

Chronic disease management the problem to be addressed Much more emphasis on organised care for chronic diseases in general practice (good!) Patients with multiple conditions often attend many clinics for each of their conditions Large admin burden on practice in recalling patients Patients often ignore recall letters Recall letters & organised clinics may not suit all types of patients No one takes a global view of the patient’s problems Non-QoF conditions may be sidelined

Anticipatory care what is it? An “upstream” activity that delays or lessens the severity of “downstream” events Health improvement activities, involving direct contact with target population Aim is to promote health & manage chronic conditions better

Anticipatory care the GP pioneers Van den Dool, in Holland (screening of all his patients, which proved to be unsustainable) Julian Tudor Hart in S. Wales We are going to focus on Tudor Hart’s model

Anticipatory care Tudor Hart’s work Deal with the patient’s presenting problem, but also with “future problems” Reactive care as well as anticipatory care Primary & secondary prevention Using “routine consultations” to deal with chronic diseases and health promotion

Anticipatory care Tudor Hart’s work Addressing patient’s immediate concerns important Patients then more willing to engage with long term conditions & health promotions Opportunistic care Using the retail idea of “footfall” to “sell” products that a person may not have deemed necessary

Anticipatory care Tudor Hart’s work Establish relationship & trust Let the patient set the pace, and let patient prioritise which conditions to deal with (negotiation) Active patient involvement

Anticipatory care Tudor Hart’s work - infrastructure High quality clinical records –Summaries of notes –Clear identification of major conditions Involvement of receptionists & nurse –Informing & recalling patients –Helping with clinical care Flagging records to identify tasks Regular audit –Measure what has been achieved –Measure what has not been achieved 9measurement of omission)

Anticipatory care Tudor Hart’s work – possible problems Not a quick fix Benefits may only be measurable after a long time Steady, cumulative approach Maintaining continuity if care can be a problem Patient co-operation needed over a long time