What we did
We created self-management pathways for hypertension, asthma, CKD, hypothyroidism and UTIs. We’ve shared some of our stuff on primarycareprotocols.co.uk. These pathways engage the patient with a plan to self-monitor their own conditions without having to attend the surgery.
For example, after an assessment, a suitable patient with hypertension has a self-management plan and follows a flowchart with key questions such as ‘Have you had your medications changed?’ If blood pressure readings are higher than target they are tasked with recording average readings over a longer period of time on their self-management plan and reporting them to their clinician.
Creating the pathways took hundreds of hours of work over the past two years, but has streamlined our internal processes, increased our prevalence and reduced our workload – each patient on the self-management hypertension pathway attends on average 2.6 fewer times per year. We have more than 400 patients on this pathway at present.
From Dr Dustyn Saint, Norfolk