Improving GP Care by Aligning Evidence, QI Methodology, IT and Contracts: A New Model for Wales

In the latest All Wales Continuous Improvement Community Awards blogpost, Dr Alastair Roeves of Aneurin Bevan University Health Board tells us how they made the most of resources at their disposal to improve their work.

Aneurin Bevan University Health Board / Bwrdd Iechyd Prifysgol Aneurin Bevan

Atrial Fibrillation is an arrhythmia resulting from irregular, disorganised electrical activity in the atria of the heart; it commonly occurs in association with risk factors, such as hypertension, diabetes and ischaemic heart disease. Evidence has shown that timely management benefits patients.

QP Pathways are clinical components of the GP Contract, designed to reduce unnecessary hospital admissions and outpatient attendances.

An Atrial Fibrillation QP pathway was produced to enable GP Practices in Gwent to implement care bundles, using Quality Improvement Methodology, when identifying, diagnosing and managing patients. It was supported by a guide developed by the Primary Care Quality team in Public Health Wales.

The QP Pathway is optional and was offered to every GP practice in Gwent. Nine practices volunteered to work as a collaborative and implement the care bundle approach to Quality Improvement. Each practice also had to use the Atrial Fibrillation module for Audit+ so the data could be analysed by Public Health Wales.

Each practice was required to show improvement in 3 out of 5 care bundles:

  • Opportunistic screening of over 65s
  • Assess symptoms
  • Perform CHADS2 / CHADS2VASc Score to assess risk of CVA
  • Manage rate and rhythm
  • Check BP, pulse, review medication, undertake anticoag risk assessment

The practices met as a collaborative on 3 occasions and agreed to share practice data between themselves and also share learning from the improvements they had put in place.

Data was extracted fortnightly by Audit+ software, analysed by Public Health Wales and supplied as run charts

Baseline data for each bundle was given to practices at the first collaborative meeting at the end of November 2013 and further data showing improvement was shared at the second collaborative meeting on 30th January 2014. Discussion between the practices identified changes they had made to improve compliance with the bundle. One practice has increased the percent of target population screened from 2 – 10% and there is evidence of improvement in all practices for the recording of pulse rate and rhythm.

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