May 2005 CHD Health Equity Audit PRIMIS Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future Vicky Smith Jane Robinson

May 2005 CHD Health Equity Audit using Primary Care Data 12 May 2005 National PRIMIS Conference Vicky Smith, Acting Primary Care Information Manager (GPPCP) Jane Robinson, Senior Public Health Information Specialist (ASP)

May 2005 What is a Health Equity Audit? The purpose of HEA is to help services narrow health inequalities by using evidence to inform decisions on investment, service planning, commissioning and delivery and to review the impact of action on inequalities.

May 2005 HEAs Identifies how fairly services or other resources are distributed Help to provide services based on relative need Distribute resources relative to health need

May 2005 HEA is a cycle It is not just a review of services Approximately a three year cycle The cycle is not completed until something changes which is likely to reduce inequalities

May 2005 HEA Cycle Use data on health inequalities to Support decisions at all levels 1. Agree partners and issues 2. Equity profile: identify the gap 3. Agree high impact local action to narrow the gap 4. Agree priorities for action 5. Secure changes in investment & local delivery 6. Review progress & assess impact

May 2005 Process at Greater Peterborough Primary Care Partnership Decide on area to audit (previous audits, knowledge of health needs of area) Established what parameters we would like to look at Director of Public Health and Primary care information manager wrote a joint letter to GP practices explaining process Primary care information team wrote and tested report style MIQUEST Queries Data collected from ALL (33) practices in GPPCP Response disks handed over to PH information lead to analyse Data quality analysed Data analysed against various variables Draft report currently being written

May 2005 Why Heart Disease? Biggest killer for both PCTs Known high incidence in high ethnic minority areas and deprived areas CHD NSF Impact of PRIMIS Impact of nGMS Increased commissioned CABGs and PCTAs several years ago and wanted to know if it was having an effect We knew that the data would be robust enough to analyse

May 2005 What we wanted to look at Risk factors for IHD – smoking, diabetes, exercise status, BMI Prevention – exercise schemes and advice, health eating schemes, access to open spaces Primary care – diagnosis and prevention treatment Secondary care – hospital activity Deaths

May 2005 Health Data Items collected Postcode Practice ID Age and gender Ethnicity Ischemic heart disease Diabetes Hypertension Hyperlipideamia Smoking status BMI Blood pressure Exercise status Aspirin Cholesterol Statins Cardiac rehabilitation Advice on smoking and exercise Non elective admissions to hospital for IHD CABGS, PCTAs procedures Death from IHD Deaths attributable to smoking

May 2005 MIQUEST Queries Looked at Report style queries for RUSH for practices These were edited to meet our needs Read Codes were based on nGMS contract business rules and PRIMIS queries

May 2005 Collection process Made appointment to visit practice Wrote query disks using MIQUEST Query Manager (local queries) Visited practices and ran local MIQUEST queries Saved responses to floppy disk Checked responses before leaving practice Returned disks to HQ and handed over to PH Analyst

May 2005 Potential pitfalls Need to access ALL practices Time to write three query sets (Vision 5 byte, Torex 4 byte and EMIS 5 byte) Time to collect data (33 practices) Technical problems with systems at some practices Need to check response disk before leaving practice

May 2005 Analysing data – primary care

May 2005 Analysing data – primary care

May 2005 Analysing data – primary care

May 2005 Analysing data – secondary care

May 2005 Analysing data – secondary care

May 2005 Analysing data – deaths Work in progress – conversion ratios for change in coding not yet performed

May 2005 Analysing data – deaths Work in progress – conversion ratios for change in coding not yet performed

May 2005 Analysing data – deaths Work in progress – conversion ratios for change in coding not yet performed

May 2005 Potential pitfalls Too many variables: length of time to perform initial profile activity for wards on the boundary probably not complete – only collected data for PCP GPs (deaths for whole ward) Data quality issues – not regularly collected items –Ethnicity 35% recorded –Exercise status 57% recorded –Exercise advice 30% recorded

May 2005 Ethnicity coding by practice

May 2005 What next? Agree draft report with those involved/ partners Publish report with agreed actions Secure changes in investment & local delivery Complete HEA Self Assessment tool kit Review progress and assess impact (2006/07)

May 2005 More information HealthAndSocialCareTopics/HealthInequal ities/fs/en spx?o=502511

May 2005 Any questions?

May 2005 Contacts Vicky Smith Acting Primary Care Information Manager Jane Robinson Senior Public Health Information Specialist

May 2005 Thank you