Issue - meetings

Dr Tamara Djuretic

Public Health Consultant, Haringey Teaching Primary Care Trust

Tamara presented a report on strokes, including mortality and morbidity data in Haringey.  Please see attached document.

The stroke pathway is complex.

Nationally and in particular in London there is under reporting on the Quality Outcomes Framework.

The West of the borough has lower hospital admission rates but higher mortality rates for stroke.  There are a number of possible reasons for this including the fact that people in the West may be less likely to present to a Dr – they may not know the underlying cause of symptoms they are experiencing.  They are also more likely to die at home.

Dr Luder noted that age is the highest risk factor for strokes, and that the West has a higher proportion of older people.

Stroke mortality across the borough is 50% higher than expected.  These are preventable deaths.

Noted that there is still work to be done in the area of strokes, particularly with regards to stroke registers. The London Health Observatory believes that only 60% of strokes/TIA are picked up in the borough.

Only a London basis Haringey can be considered to be doing ‘okay’ but there are large variances across practices.

Secondary prevention is being managed quite well in Haringey, but it is acknowledged that this is the tip of the ice berg.

Query as to the extent of under reporting – noted that this is at all levels of the stroke care pathway including those at risk of having a stroke.  There is currently no feel to what extent this under reporting is.

Issues include information not being registered properly or at all.  There is sometimes an issue with the IT literacy of some GPs, which may then rely on non-clinicians.  This may cause problems with recalling patients.

There are also issues around people simply not turning up when they have been recalled.

Importance of the concept that “stroke is a preventable condition” noted.

There are a number of variances across the borough in relation to the hypertensive register.  The possibility of looking at the age profile of each practice area and comparing this with the hypertensive register was discussed.  The TPCT have agreed to look at this.

The Vascular checks which will be rolled out in 2009 should improve primary prevention.

Points of discussion

Use of text messaging to remind people of their appointments.  Noted that if you send a patient a text they are highly likely to respond within 30 minutes, which is not the case with letters.   Query as to whether this could be considered for investment?

Noted that older people may not be likely to have a mobile phone.

Noted that blood pressure checks to do have to be carried out by a Dr, they can also be carried out by other health care professionals.  Query as to how many professionals go to the homes of people who are not able to get to practices.

There is a need to find a  ...  view the full minutes text for item 24