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Taking cardiac care - being part of 'SUCCEED'

How did they tackle the demands of SUCCEED at Leybourne Surgery, Bournemouth?
What needed to be done?
What improvements have been made?
For more information about the experience at Leybourne Surgery contact:
Leybourne Surgery joined SUCCEED when it was launched in 1997. Andrew Foot, one of the two partners, had been involved as the project started to take shape. He was nominated as care manager. His earlier involvement meant he could explain the requirements to his colleagues.

What needed to be done?

Interrogation of electronic patient records proved reliable and enabled the practice to readily identify the patients (220) who would need to be assessed within the pathway. Using an established template in the system these records provide a validated practice-based ischaemic heart disease (IHD) register. At about 6% of the practice population this is marginally higher that national levels.

The challenge was to find ways to manage the reviews of the patients within the context of a busy practice. They decided to tackle this in two ways. First, be opportunistic and review IHD patients who attended surgery for any reason. Second, to invite groups of patients to a series of evening sessions. The aim was to invite (by letter) groups of about 20/30 patients to each evening session.

Time was be set aside before the sessions for a team briefing to ensure that all those involved understood their role and that of other members of the team: all singing from the same hymn sheet ! The sessions would start with short talks to explain the reasoning behind the pathway. Practice staff (GPs and practice nurses) and other local staff (district nurses, therapists and dieticians) were involved, as well as the SUCCEED project nurse. After the introductory talks patients were seen individually to review their treatment. A patient-held record card was completed to define what was expected of the practice and the patient.

What improvements have been made?

Between Autumn 1997 and Summer 1999 the practice reviewed the treatment of all their IHD patients. Four evening sessions were needed to accommodate about half of the patients on the register. About 80% turned up to their allocated evening session. The remaining patients were seen as part of normal everyday business. The accommodation costs of the evening sessions were met by Merk, Sharpe and Dohme as part of their sponsorship of SUCCEED.

A recent audit of the patient records has demonstrated the progress being made - three key parameters are shown in Table 1. Two particularly difficult aspects have been smoking and weight. When people stop smoking they tend to put on weight. The practice has found that individual counselling with the GP is the most effective method of helping patients deal with this. They are also looking at a role for a specialist IHD nurse

Table 1: Audit of SUCCEED at Leybourne Surgery
Percent of patients with: Target Actual May 2000 Previous year New Target for 2002
Aspirin prophylaxis 80 83 73 85
Cholesterol <5.0 mmol/L 70 58 46 70
Blood pressure <140/80 90 95 85 97

The availability of the IHD register provided a good starting point. Ensuring that all IHD patients were reviewed within the pathway has added to the pressures on practice staff. It was difficult to find the time required. The strength of the evidence and acknowledged benefits of better cardiac care was persuasive: it was an aspect of primary care where staff could really make a difference. They could save lives and improve health. Because of this there have been no major problems. The work has given a welcome new role to practice nurses. Patients have liked the evening sessions and have responded positively to the use of the patient-held record.

For more information about the experience at Leybourne Surgery contact:

Dr Andrew Foot
Leybourne Surgery, 1 Leybourne Avenue
Ensbury Park, Bournemouth BH10 6ES

Telephone 01202 527003 Fax 01202 549339


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