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 way of ensuring people go into their surgeries to get checks?
· How to you persuade people to do this?
· How do you subsequently get people to take their medication (when there may be unpleasant side effects to them as opposed to high blood pressure which can not be immediately felt). Query as to how big the compliance problem is with medication. GPs and Clinician believe that this could be significant and as high as 30%-40%.
· Compliance needs to be linked with an awareness and understanding of the implications of not taking your medication/having you blood pressure monitored. Notion of ‘it won’t happen to me’ needs to be broken down.
· Concordance – an initiative to involve the patient in the treatment process and so improve compliance.
Query as to the success of engagement with the Expert Patient Programme in relation to strokes.
Dr Luder raised the importance of awareness and how someone who has suffered a TIA may be more able to identify with the consequences of their lifestyle/not taking their medication/not having their blood pressure monitored, than someone who has never experienced any of the symptoms.
At the same time there needs to be a high level of awareness of stroke risks, what the symptoms are and also that it is a medical emergency and that you should call 999.
There is an element of fatalism surrounding strokes. People are not aware that there is something that can be done about it.
What is the user experience of gain ing access to information? How easy is it for users to get information at different stages of the care pathway?
Noted that there is a diagnostic issue with TIA’s – is it a TIA or a ‘funny turn’?
Discussion around the sessions run by the Whittington when a person is diagnosed with Diabetes. Sessions are conducted in a brutally honest way which ensures that people take notice.
Could something similar be considered for TIAs/high blood pressure patients.
Dr Luder, Robert Edmonds and John Murray will meet to discuss an Expert Patient Programme pilot at the North Middlesex Hospital.
Importance of linking the acute sector with the voluntary and community sector.