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Workload implications of identifying patients with ischaemic heart disease in primary care: population-based study
Jeremy Gray1, Matthew Ekins, Amy Scammell
1Battersea Research Group, Bolingbroke Hospital, London SW11 6HN. Jeremy@brg123.net
Insights
Developing ischaemic heart disease (IHD) registers in primary care is efficient. A centralized search identified IHD cases cost-effectively, improving patient management and secondary prevention strategies.
Area of Science:
- Cardiology
- Public Health
- Health Informatics
Background:
- Ischaemic heart disease (IHD) management requires accurate patient registers.
- Primary care groups (PCGs) in SW London aimed to establish IHD registers.
- Key objectives included identifying existing IHD patients and estimating register creation workload.
Purpose of the Study:
- To develop IHD registers in three SW London PCGs.
- To ascertain the proportion of IHD patients already identified.
- To estimate the workload and cost associated with creating IHD registers.
Main Methods:
- A population-based, cross-sectional study was conducted in 46 general practices across three PCGs.
- Computerized and paper medical records were utilized for data extraction.
- Methods involved verifying existing IHD codes and searching for uncoded cases among patients on specific cardiovascular medications.
Main Results:
- Out of 3803 patients with IHD codes, 15% lacked evidence of IHD, leaving 3233 confirmed/probable cases.
- An additional 1447 cases were identified by searching records of patients prescribed cardiovascular drugs.
- Register creation involved 4.9 hours per 1000 list size, with an average cost of £10.20 per identified case.
Conclusions:
- A centralized search program efficiently identifies IHD patients at a low cost.
- This method is valuable for improving IHD patient management and secondary prevention.
- Primary care trusts can utilize this approach to enhance IHD care delivery.
Background:
The aims of this study were to develop ischaemic heart disease (IHD) registers in three primary care groups (PCGs) in SW London; to determine what proportion of patients with IHD were already identified; and to estimate the workload in producing an IHD disease register.
Methods:
A population-based cross-sectional study was carried out in 46 out of 49 general practices in three PCGs in SW London, using computerized and paper medical records. Outcome measures were proportion of patients with IHD on existing disease registers, and workload and cost of producing complete registers.
Results:
Of 3803 patients with a pre-existing IHD Read code, 570 (15 per cent) were found to have no evidence of IHD, leaving 3233 patients with confirmed or probable IHD. A search of 7726 patients prescribed one of five cardiovascular drugs but not already coded as having IHD identified a further 1447 confirmed or probable cases. On average, coders spent 4.9 hours per 1000 list size verifying IHD cases or finding uncoded cases. Each additional IHD case required about 0.68 hours (41 minutes) of coder's time to identify and one case of IHD was identified or confirmed for about every five sets of notes examined. The cost of each additional case identified was about pounds sterling 10.20. At practice level, there was a wide variation in the proportion of IHD patients already on the register or wrongly coded as having IHD.
Conclusions:
A centralized search programme can identify patients with IHD efficiently and at relatively low cost. As the identification of cases is an essential first step in implementing effective secondary prevention, other primary care trusts may also find this method useful in improving the management of patients with IHD.
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