Guidelines

Optimising your patients’ recovery after stroke

Around 150,000 people in the UK have a stroke every year, according to the Stroke Association. Most people affected are over 65, but younger people can have a stroke. Stroke is the third most common cause of death in the UK and is also an important cause of disability, with more than 250,000 people left disabled following a stroke. The recent National Stroke Strategy for England set out a quality framework to improve stroke services. In this article, we review what we can do to help optimise outcomes for our patients who have a stroke.

Acting on the latest nice guidance on secondary prevention of myocardial infarction

The latest National Institute for Health and Clinical Excellence (NICE) guidance on the secondary prevention of myocardial infarction (MI) is designed to help us achieve even more impact in reducing cardiovascular deaths, with updated recommendations on drug therapy and clear advice on diet, physical activity and smoking cessation. This article gives you a summary of the aims of the guidance and highlights issues of particular interest to primary care nurses delivering CVD management in practice.

Optimising the prevention and management of obesity: putting NICE guidance into practice

Obesity is a rapidly growing problem in the UK. Department of Health statistics show that the prevalence of obesity in children under 11 years of age rose from 9.9% in 1995 to 13.7% in 2003, and in adults obesity prevalence has trebled since the 1980s, with more than 50%, (almost 24 million adults), now being classed as overweight or obese. In the article, we review the latest guidance from the National Institute for Health and Clinical Excellence (NICE) on how to prevent and manage obesity in practice.

Hands on Hypertension: Getting to Targets in Practice

Hypertension affects one in five people in the UK and is poorly managed despite a range of drug and lifestyle interventions known to be useful and effective. We are constantly reminded about the importance of getting people to target with blood pressure (BP) treatments but this can be easier said than done. In this article, we will look at the challenge of getting blood pressure readings down to target levels and we will work through some case studies to explore possible solutions to achieving the targets in practice.

What is New in the QOF?

The Quality and Outcomes Framework (QOF) has been a huge success and primary care in the UK is now delivering some of the best results in the world for the management of chronic disease. The Department of Health is obviously keen to continue to drive up quality in existing domains and extend the QOF to new areas of health care, with an updated list of indicators published earlier this year. In this article we explore what has changed.

Managing Hypertension: Updated NICE Guideline

Back to Basics: Calculating cardiovascular risk: ‘How To’ guide for the new British Guidelines

Calculating cardiovascular risk is at the heart of primary prevention – it gives us a practical way of assessing who we should be targeting with lifestyle changes and drug treatment to reduce the chance of them suffering a heart attack or stroke in the future. The new Joint British Guidelines make it very clear who we should be screening for CVD and how to calculate their risk.

New Joint British Guidelines on CVD Prevention

Nearly 250,000 people die each year in the UK from cardiovascular disease (CVD), despite all the hard work of healthcare professionals. The new Joint British Societies’ Guidelines on Prevention of Cardiovascular Disease in Clinical Practice (JBS2), published recently by all of the leading societies working to reduce CVD in this country, take a ‘get tougher’ approach to further reduce CVD deaths. They widen the range of patients who should be included in primary prevention, in addition to setting lower targets for total cholesterol (4.0 mmol/L), low-density lipoprotein (LDL) cholesterol (2.0 mmol/L) and blood pressure (140/85 mmHg).

Scoring QOF points for stroke and TIA

In the fourth article in our series on the Quality and Outcomes Framework (QOF) we will look at stroke and transient ischaemic attack (TIA). This is an area that has probably been ignored in many practices with regard to secondary prevention. It was not included in any of the previous NSFs and there had been no targets to encourage evidence-based treatment in Primary Care, up until the arrival of the QOF.

Hypertension: the big one for QOF points

In the third article in our series on the Quality and Outcomes Framework (QOF) we are reviewing how to score top marks for hypertension. This is probably the most difficult condition to treat to target but with careful attention to regular monitoring of patients with high blood pressure, treatment based on latest guidelines and careful recording of the outcomes of patient consultations, all practices should be able to gain points in this area.

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.

Beta blockers

Beta blockers are well established drugs in the treatment of cardiovascular disease, after first being introduced 20 years ago. Today, they are used to treat patients with a range of cardiovascular conditions – hypertension, myocardial infarction, angina, heart failure and abnormal heart rhythms (arrhythmias). There is good evidence for beneficial effects with beta blockers and their use is recommended in many guidelines, including the recent British Hypertension Society guidelines. Prescribing of beta blockers in patients with heart disease is further encouraged as a ‘quality marker’ in the new GMS contract.

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