Patients with diabetes are at high risk of cardiovascular disease and aspirin is an important part of prevention strategies. Although it is effective and relatively well-tolerated, studies have shown that many patients with diabetes are not taking aspirin. In this article, we review why aspirin should be considered in patients with diabetes, the benefits it might achieve and areas where caution is required.
Making sense of the Quality and Outcome Framework of the new GP Contract
The Quality and Outcome Framework (QOF) of the new GP Contract will be the biggest experiment in improving the quality of care for patients anywhere in the world. By April 2005, we will see how well Primary Care can deliver. In this series, we provide a step-by-step guide on how your practice can get QOF points, including practical information on what data to collect and how to record it. Over the coming months, we will be discussing the best ways to maximise the quality of care and will concentrate on the cardiovascular and diabetes elements of the QOF. We will discuss the setting up of registers, practical tips, examples from practices that are delivering well, how to check how well you are doing from your own IT system and from Quality Management Analysis System and, of course, how to deal with exception reporting and the PCT QOF visit.
Oily fish and cardiovascular disease
The management of cardiovascular disease (CVD) in primary care has been transformed in recent years, particularly with extensive use of statins in secondary prevention. But what about the less high-tech approach of getting patients to eat more healthily? Dietary advice has traditionally been offered primarily to those needing to lose weight or lower their lipid levels. But more recently, systematic reviews have shown good evidence that dietary changes can reduce mortality and morbidity in addition to modifying some risk factors in patients with coronary heart disease. Evidence to date suggests similar benefits of healthier eating are likely in primary prevention. In this new series – Food for Thought – we sort the wheat from the chaff when it comes to dietary advice for patients with cardiovascular disease. This article will focus on the benefits of oily fish, with the good news that simply increasing oily fish intake achieves major benefits.
Practical approaches to empowering people with cardiovascular disease or diabetes
For people with long-term conditions, self-care can have as much, if not more, influence on their health than prescribed medication and treatment. Yet, in many cases, healthcare professionals become frustrated when attempts to improve peoples’ self-care behaviours prove unsuccessful. This article looks at some of the reasons why it can be difficult to encourage people with diabetes or cardiovascular disease to look after themselves effectively; what types of practice can help us to increase people’s success in managing long-term conditions; and how we can incorporate empowering techniques in our day-to-day consultations.
Sex after an MI
Rehabilitation after a myocardial infarction (MI) includes all aspects of a patient’s life – medical, physical and social. Sexual functioning is an important part of most people’s lives. Fears about whether having sexual intercourse could trigger another heart attack is the question many post-MI patients want to ask but embarrassment may stop them. Giving accurate information about sex after an MI is just as much a part of patient education as telling them about cholesterol and blood pressure and can go a long way to helping recovery and preventing further problems such as sexual dysfunction.
Stroke and TIA
Stroke is common, affecting around one in four people over the age of 45 at some time in their lives. Increasing age is a major risk factor for stroke, so the numbers of people suffering a stroke will increase with the ageing population. Primary care teams have a central role in providing effective secondary prevention, but because patients often fall between primary and secondary care, things may be missed. Taking a systematic approach to assessing risk factors, such as blood pressure, and treating them effectively can significantly reduce further stroke risk.
Quality … and beyond
Quality is the latest buzzword in healthcare. The latest GMS contract emphasises this in the Quality and Outcomes Framework (QOF) designed to measure and reward key elements of primary care chronic disease management. In this issue of BJPCN we start a new series – Points mean Prizes – on how to make sure you get all the ticks in the boxes for the data you need to collect to get maximum QOF points. The series will provide a step-to-step guide on how to score on the 76 quality indicators in the 10 clinical domains of care.
Optimising treatment of type 2 diabetes with metformin
There is good evidence that tight glycaemic control significantly improves outcomes in patients with type 2 diabetes. All practice nurses will be looking to achieve the new General Medical Services contract (GMS2) targets for HbA1c reduction in diabetes (see box). Practices will be developing prescribing strategies to achieve this reduction, in accordance with good clinical practice. Metformin offers an important first-line therapy for type 2 diabetes. The introduction of a new, sustained-release formulation – Glucophage SR – should improve patient compliance with metformin and so improve glycaemic control.
Talking to Practices
Rosemary Evans, practice nurse at a Docklands practice, London, talks to BJPCN about why and how she set up her smoking cessation service
Disease Focus on… Angina
Angina is a common problem in primary care, affecting around one in every six patients aged 65 years and over. It ispredominantly chest pain due to transient myocardial ischaemia caused by coronary artery disease. Episodes of angina are typically caused by exertion or emotion, and are relieved by rest. Treatment with drugs and/or surgery that improves blood flow to the heart and lifestyle changes can significantly improve patients’ quality of life and survival.
Optimising the treatment of type 2 diabetes with newer insulins
Primary care nurses play a central role in the management of type 2 diabetes in the community. This includes helping patients to use their drug treatment correctly. Although many patients with type 2 diabetes initially respond well to weight loss and exercise, most require oral hypoglycaemics and half of all patients eventually require insulin to control their glucose levels in order to prevent the devastating long-term complications of inadequately controlled diabetes. Linda Goldie gives an up-to-date review of the newer insulins – including the insulin analogues, insulin lispro, insulin aspart and insulin glargine – that have been introduced.
Tackling the burning issue of smoking cessation
The number of people who smoke has fallen over the past 30 years under a barrage of tobacco control measures, including increasing the price of cigarettes, advertising bans, and health education campaigns. But, one in four premature deaths in the UK (adults aged 35–65 years) are still caused by smoking, and a study published recently warned that today’s smokers puff their way through more cigarettes and start at an earlier age than smokers of fifty years ago. This means that, on average, men who smoke now die ten years earlier than men who don’t smoke. Can primary care make an impact on this ongoing problem? The good news is yes – and the new GMS contract is finally offering us incentives to include smoking in our health promotion activities. In this article, we give you the ammunition to put smoking cessation on your agenda – with the health and economic reasons why it makes sense to help patients quit. Practice nurse Rosemary Evans then explains how she does it in her Docklands practice.
