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Diabetes Clinical Audit- July/Aug 2014
147 new patient referrals and 178 follow up referrals were audited. Jamie- can you complete the numbers based on returns
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Some Facts There is significant growth in diabetes prevalence and service demand for care in the future. Currently over 15,000 adults in SW with diabetes, 80-90% of which possess type 2 diabetes. This figure is destined to rise with new diagnoses expected each year. It is estimated that a further 10-15,000 people remain undiagnosed. Actual prevalence is expected to grow from 7.5% in 2012 to 9.4% in 2030, which will be higher than the England national average. We have seen a 22% increase in new patient attendances and 10% increase in following up appointments over the last two years (11/12 to 13/14) across diabetic medicine outpatients for SW.
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QOF Position as of 12/13 13/14 data not yet available
Indicator SW Value and CCG ONS ranking 2011/12 SW Value and CCG ONS ranking 2012/13 SW Value against CCG ONS ranking 2012/13 Trend Aspirational target (to be in top 10% of ONS group 2012/13) Practice distance from target DM % patients with diabetes in whom last HbA1c is 8 or less (formerly DM27) 77.2 72.3 73.5 1 73.0 0.4 DM003 - % patients with diabetes in whom last BP is 140/80 or less (formerly DM31) 64.0 66.0 73.2 71.4 1.8 DM004 - % patients with diabetes whose last measured total cholesterol is 5 or less (Formerly DM17) 71.7 70.8 74.1 75.3 -1.2 DM005- % of patients with diabetes, on the register, who have a record of an albumin: creatinine ratio test in the preceding 12 months 83.1 82.2 82.1 87.2 -5.1 DM007- % of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months 68.3 63.9 66.1 64.2 1.9 DM012- % patients with diabetes, on the register, with a record of a foot examination and risk classification 84.1 85.4 85.5 88.3 -2.8 DM002- % of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less 86.1 86.0 88.7 88.6 0.1 DM006- % of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with ACE-I (or ARBs) 80.9 79.8 81.7 84.3 -2.6 Top 10% Top 10-25% Top 25-50% Bottom 10-50% Bottom 10% 68.3 81.7
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First Out Patient referrals
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Jamie- can we increase font size of x axis, don’t think they will be able to read
can we add % of patients as well as number of patients Can we colour code to full LES , partial and non LES
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Could referred patients have been managed differently?
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Can % be added and LES non LES colour code
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Who sees the Type 2 patients referred?
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Increase font on x axis
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Thoughts Diabetic medical management increasingly complicated as so many new drugs (increasingly within class). Confusion with which drugs are allowed to be initiated within primary care. Many practices have a lead in DM which is increasingly needed when treatment regimes get more complicated. Many referrals for Insulin or GLP1 initiation could these be done in practice. A common reason for in retrospect being able to have dealt with the referral differently was awareness with what practices already have. Very little referrals for preconception ? Should we refer more? Many more patients where referred for DSN advice but saw a consultant first before being referred on to the DSN.
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Follow ups
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If under shared care could you manage the patient solely in primary care
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If under hospital care could you manage the patient under shared care
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Thoughts on follow up Patient choice is a factor in 12%.
Many patients followed up for years. GP’s who conducted the audit felt >50% could have increased follow up in primary care. This is the first time in years we have looked at this. Is there a way of changing substantially what happens. Challenging the inertia? Secondary care is concerned that if they discharge patients with suboptimal control to primary care they may just be referred back.
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