Dr Dustyn Saint describes how his practice used enhanced communication with patients and audits of medical records to hugely increase the number of patients on disease registers
Recent changes to how QOF points are calculated could have dealt a major financial blow to our practice.
We are a rural practice in an affluent area. Our disease prevalence was relatively low and the removal of the QOF square root formula last year could have disproportionately affected us.
But we made sure this did not happen. Through a combination of enhancing communication with patients and a systematic approach to reviewing practice records, we have boosted our prevalence scores by 97% over the past three years and protected our income from the QOF.
This is a project that every practice can undertake to boost their QOF income – not just ones in low-prevalence areas – and it has the additional benefits of improving patient care, raising the practice's profile and increasing dispensary income (if you have one). A triple whammy.
Here's how we did it.
Improving patient communication
We decided the central plank of our strategy would be to revamp the way we communicated with patients. We wanted to ensure that we were reaching all those who might be at risk of certain diseases, and make sure they were given information that would aid diagnosis and optimise management.
We discussed with our practice manager the ways we communicate with our patients and thought about new methods of getting our message across.
Our practice has always prided itself on being at the forefront of technology to aid communication with patients. We have long had our own website and intranet, which were created by our in-house team.
We decided to use the following routes of communication to reach patients who might have as-yet undiagnosed conditions:
• our practice leaflet
• appointment cards
• practice website
• patient display boards
• practice intranet.
We also had some money to use from our prescribing incentive scheme and decided to invest this in plasma televisions to display information to patients. We later found that income from advertising more than offset the initial set-up costs.
We conducted a number of brainstorming sessions in the practice about what kind of information would lead to us making new diagnoses.
We came up with a set of key messages for patients, designed to prompt them into questioning whether they might have an undiagnosed illness. These included:
• COPD: Do you smoke? Do you produce a lot of mucus? Do you cough or wheeze?
• Asthma: Are your symptoms preventing you sleeping or interfering with your usual daily activities?
• Hypertension: Ask at reception to borrow one of our home monitors.
• Prostate problems: Do you have a poor stream of urine, do you have to wait at the toilet for it to start flowing?
A full set of the messages we used are available here
We also provided information designed to improve patient care and promote cost-effective use of medications:
• reminders to patients with diabetes to self-check their blood sugars
• a video detailing asthma inhaler technique
• advice about what to do when asthma is poorly controlled.
We designed a system – the GP Oracle – through which all information in various communications from the practice could be updated in one place and distributed to all communication channels (practice website, intranet, display boards and practice leaflet). This meant all information was kept up to date from one easy location.
Drug audits
Increasing prevalence requires not only the diagnosis of new patients but also that existing patient care be properly characterised. We therefore conducted audits of the medications patients were taking to identify those who might not have been correctly coded. We did searches to identify people who were on inhalers but who were not coded as asthmatic and then made sure that we had an appropriate diagnosis, calling people back for a review if necessary. We also did searches for people on antihypertensives, glycaemic agents and thyroxine, among others. We were able to code substantial numbers of patients with coronary heart disease, asthma, hypothyroidism and heart failure.
Results
From 2007 to 2010, our QOF prevalence increased by over 96% – partly because of this project to reach out to patients. This has meant that we have been less adversely affected by the QOF changes.
Figures below show the increases in prevalence that have occurred because of our systematic approach to diagnosis.
We were especially pleased that smoking reduced by 8% and that our targeted campaign to diagnose possible COPD patients brought a 25% increase in our prevalence. We were astounded that our depression prevalence had increased by such a large amount – we did have material to highlight depressive symptoms and it appeared to have led to many more diagnoses (although the credit crunch may also have had an effect).
The areas (see below) were targeted mainly through drug audits, which were quite successful at picking up where patients were on medication for a condition that did not appear to have been coded correctly.
This made us look in much more detail at the processes for coding new diagnoses.
We are beginning to offer our GP Oracle system to other practices and have developed a useful additional income stream by including advertising from local health-related companies that are keen to promote their services through GP surgeries. We are building an online community of patient resources, which practices can then pick and choose from (as well as add to) and are offering surgeries the chance to use this new system for income generation with advertising.
Dr Dustyn Saint is a GP in Solihull. See www.gporacle.co.uk for more information about the system
Diabetes +11%
Hypertension +9%
COPD +25%
Mental health +50%
Stroke and TIAs +29%
Smoking in chronic disease -8%
Dementia +200%
Depression +1,260%
Coronary heart disease +17%
Asthma +93%
Hypothyroidism +26%
Heart failure +17%
