1. Tina Huang

2.  Aimed at people aged 40 – 74  Risk assessment and management programme to prevent or delay the onset of diabetes, heart and kidney disease and stroke

3.  CVS risk –  Age  Gender  smoking status  physical activity  FH of coronary heart disease  Ethnicity  BMI  cholesterol test (random)  Blood pressure ◦ All required for Qrisk score

4.  Diabetes risk – Identifying high risk (BMI/BP)  Hb1ac or FBG  Alcohol risk ◦ Initial screen – Audit C or FAST ◦ Second phase - Audit

5.  Dementia – Age 65 – 74 ◦ Signs and symptoms of dementia, raise awareness no formal assessment ◦ Memory services signposted  Follow up – face to face with lifestyle advice, diagnosis coded

6.  Risk assessment ◦ To see if all the tests and measurements are being carried out ◦ To see if they were done correctly  If they were not carried out then assessing the possible reasons  To review if the abnormal findings were followed up

7.  During a NHS health check 100% of patients must have – age, gender, ethnicity, smoking, FH of CVD, BP, BMI, physical activity, auditC/FAST, Cholesterol, Qrisk, dementia awareness, diabetes risk, lifestyle advice, and to have diagnosis coded  If any were abnormal then must have follow up

8.  Coding searched: NHS health check completed were searched on Emis  890 patient’s found  Around 1 in 20 were selected  No. of pt audited – 47

10.  All but 1 patient were eligible  Ethnicity – 11% documented  Smoking – 74% documented ◦ 5 out of the 6 patients who were smokers were offered smoking follow up  FH of CVD – 60% documented  Blood pressure – 94% documented ◦ 8 out of 13 patients at risk did not have follow up

11.  BMI – 89% documented ◦ 7 out of the 23 patients at risk were not signposted  Physical activity – 77% documented ◦ 4 out of the 11 patients at risk not signposted  AuditC/FAST – 27% documented ◦ All of the 2 pts that needed follow up did not have follow up  Diabetes – 74% had Hb1ac ◦ 5 out of 5 patients who had abnormal levels had follow up ◦ 7 out of the 12 patients (who did not have a Hb1ac) - Blood requested but bloods not done

12.  Cholesterol – 83% had lipids done ◦ 7 out of 8 pts (who did not have lipids done) – Bloods requested but pt had not done blood test  Qrisk – 87% documented ◦ Documented despite no cholesterol level ◦ Qrisk follow up – 4 out of 5 were followed up and started on statins  Dementia – 4 patients were over 65 y/o, 2 of these patients had memory service signposted to them (50%)

13.  57% patients did have face to face follow up  47% patients received lifestyle advice  100% patients had their diagnosis coded

14.  7 patients were issued blood request forms, however these were not done, and had no follow up - These were still coded as NHS health check complete  Values for ethnicity and FH of CVD inaccurate due to limitation of template  AuditC/FAST scores on 3 rd page ◦ Of the 2 patients that were identified to be at risk, no follow up was recommended

15.  Blood pressure, 8 patients had no follow up appt made, patients had no set follow up date  Need to signpost weight management services and exercise services  Qrisk and diabetes follow up very well  Age over 65 – need to signpost memory services  1 pt who was not eligible – Qrisk was not followed up as age 79, Qrisk >30, already on statins

16.  Adjusting the NHS health check template ◦ Audit C score being on the first page ◦ Having the option of ‘no family history’ on FH of CVD ◦ Making selecting a follow up date compulsory on the template  Follow up ◦ ensuring a follow up date is made  Coding of NHS health check indicated if blood tests not completed/ consider giving patients blood test forms prior to their NHS health check appointment  Raising awareness – dementia, audit C score

17.  Performing the audit C/FAST score, dementia awareness could be improved ◦ Possible reasons for above could be due to location on NHS health check template, not aware to document dementia awareness  Follow up may be improved if a follow up date is selected during NHS health check ◦ Blood pressures that need follow up – arrange follow up date during consultation  Coding ‘NHS health check completed’ post blood test results