Professor Allen Hutchinson, Director, Clinical Practice Evaluation Programme

The Clinical Practice Evaluation Programme (CPEP) supports effective practice by general practice teams for important common conditions, one of which is coronary heart disease (CHD). Further details on how CPEP works can be found in 'Key organisations' .

For CHD we chose three areas of primary care management: stable angina; post-myocardial infarction; heart failure.

In developing ideas for the performance review criteria – which have come to be at the core of the project – we decided on a number of principles:

  • Many practices had already reviewed their work on CHD so there was a need to recognise that skills and experience in this topic varied across general practice.
  • The criteria would be derived from recommendations and statements about particular aspects of care drawn from the best available evidence-based guidelines, and presented in a form to support clinical record review. We would not build the evidence base ourselves.
  • Review criteria would be developed that could be used for a variety of purposes, such as qlinical audit, the basis for local standards of care, or developing local indicators of quality in health care.

We examined and evaluated a range of evidence-based guidelines on these topics, although for many it proved difficult to determine the link between the evidence for good practice and the good practice recommendations. We then identified important aspects of care and subsequently grouped these into clinical assessment, therapy, and advice for patients. The resulting set of review criteria for angina is shown in the box below.

CPEP review criteria for stable angina
Clinical assessment

1.

The % of patients with stable angina who have had their blood pressure measured
2. The % of patients with stable angina who have had their serum lipids measured
3. The % of patients with stable angina who have had their BMI checked at diagnosis
4. The % of patients with stable angina who have had an exercise test
5. The % of patients with stable angina who have had their haemoglobin measured to identify those with underlying anaemia
6. The % of patients with stable angina who have had their blood glucose measured to identify those with diabetes mellitus
7. The % of patients with stable angina who have had a resting 12-lead ECG
Therapy

1.

The % of patients with stable angina who have been treated with aspirin 75mg daily, unless contraindicated
2. The % of patients with stable angina who have been treated with short-acting nitrates as required in response to pain and before performing activities known to bring on pain, unless contraindicated
3. The % of patients with stable angina who require regular symptomatic treatment who have been treated with a beta-blocker, unless contraindicated
Advice

1.

The % of patients with stable angina who smoke and have been advised to stop
2. The % of patients with stable angina who have been recommended moderate exercise within their capabilities to improve general fitness and wellbeing

More than 60 GPs helped to rank the aspects of care by clinical importance, so that if a practice decided to start with assessing care for only (say) the top one or two criteria in each group, or decided to limit the amount of information they handled, then they would do so knowing that their peers had determined that this was a good place to start.

This is important because the problem for generalist clinicians such as GPs and practice/community nurses is that they may end up having to capture information on many health problems – data capture overload is a real issue.

For more information on the whole CHD list of review criteria, contact your PCG clinical governance lead, who should have a document containing all the criteria. Alternatively, the information can be downloaded from the project website at www.shef.ac.uk/~scharr/publich/cpep.

 

Guidelines in Practice, June 2000, Volume 3
© 2000 MGP Ltd
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