evidence in general practice

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Pacific HRC Conference The Use of Evidence in General Practice ProCare Health Limited August 2007


Outline ProCare WHAT!? ProCare – Systems of Care Cardiovascular Risk (CVD) Predict II Auckland Pacific Community Project ProCare Vision

ProCare What?!: 

ProCare What?! 3 PHOs 519 GPs 450 PNs 177 Practices GP Services CHC teams HP teams PPS HML Maori / Pacific Over 130,000


Screening / Prevention Health Promotion Chronic / Ongoing Acute / Episodic Common Features Long term conditions Regular scheduled patient contacts Patient held wellness plans Standard PHO reports Common Features Defined target population Recall systems Standardised data collection Standard PHO reports Common Features Standardised claim form / amount Explicit patient eligibility Standard referral process Standard PHO reports Common Features Applies to all patients Generic messages Decision Support Decision Support Decision Support Decision Support Incentives / Extra Funding Incentives / Extra Funding Incentives / Extra Funding Incentives / Extra Funding


Screening / Prevention Health Promotion Chronic / Ongoing Acute / Episodic Decision Support Decision Support Decision Support Decision Support Incentives / Extra Funding Incentives / Extra Funding Incentives / Extra Funding Incentives / Extra Funding U22 / U25 ProExtra Smoking Cessation Care Plus CCM CVD Diabetes Get Checked Heart Care Palliative Care POAC Post Natal Depression Predict II Parish Community Nurse Housing Insulation Muslim Women’s Swimming Programme Kaipara Outreach Community Health Coordinators Engage®


In a population of 10,000 primary care patients, each year there are about: 80-100 coronary & stroke events 1 diabetic death 5 breast cancer registrations 1 cervical cancer registration 1 suicide BMJ 1994;308:1019-22 Why bother about CVD at 1°Care

Pacific CVD Statistics: 

Pacific CVD Statistics Pacific peoples both male and female are more than Double the CVD risk than the NZ population!


Leading cause of death & hospital admissions in NZ 9,000 deaths from CVD each year Approx 30% under the age of 70 yrs 500 deaths on the roads 600 deaths from breast cancer CVD NZ CVD Statistics


In 2002 CMDHB, ProCare, Ministry of Health & NHF U of A co-ordinated clinical team from CMDHB and ProCare, NZGG, NHF, IT team from Enigma 2003 University of Auckland HRC Research Grant Primary care management of CVD risk (risk prediction and risk burden) Predict CVD 2003 CCM CVD module 2004 ‘Acute PREDICT’ PREDICT History


Use Information Technology to provide on-line web-based CVD risk assessment and management advice which is: Fast User Friendly Integrated with patient electronic record Guideline and evidence based Individualised recommendations for each patient The use of Predict II


PREDICT – CVD Evaluation Study 2004 (NZMJ2006): four-fold increase in risk assessment


Now both guidelines are in PREDICT 2 2003 NZ CVD Risk & Diabetes Guidelines


2003 guidelines as decision support content Aligned with new Diabetes Get Checked Integrated with MedTech, My Practice and Profile PMS- fills in more data for you wherever possible, saves back to patient record “Smarter” template Calculates BMI, Metabolic syndrome, eGFR Checks lipid profile (Friedwald Equation) Checks BP Cross checks with other fields, only allows valid epidemiological values Provides reports that are easy to access and customise PREDICT II

ProCare GPs (& ADHB): 

ProCare GPs (& ADHB) All ProCare GPs have installed Predict II Assisted other PHOs to have Predict II Starting the slow process of engaging patients to be screened Designated Nurse screening at large Pacific practices (with 2,000 or more enrolled Pacific patients)

Auckland Pacific Community Project (APCP): 

Auckland Pacific Community Project (APCP) Taking Predict II to the Pacific communities Collaborative approach with NHF, ADHB, PIHB and PNA Initial screening included: DML providing blood tests; Church Health Community engaged.

APCP photos: 

APCP photos

APCP outcomes: 

APCP outcomes Large number of participants screened had high CVD risk A few were undiagnosed diabetics Current diabetics were not managed Ongoing health promotion programme within the church Linking ‘high risk’ members with GP

APCP team: 

APCP team

ProCare Vision: 

ProCare Vision Every enrolled Pacific patient is screened through Predict II Proactive management of Pacific patients through general practice / church setting Working collaboratively with Pacific providers for Pacific communities

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