Keep Well 2013-14 - Hi-Net Grampian · per CHP is: Aberdeen City 23, Aberdeenshire 9, and Moray 2....
Transcript of Keep Well 2013-14 - Hi-Net Grampian · per CHP is: Aberdeen City 23, Aberdeenshire 9, and Moray 2....
Keep Well 2013-14
Analysis of
Keep Well practice data
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Keep Well 2013-14 NHS Grampian
Keep Well 2013-14
Analysis of Keep Well practice data
Background
The following tables are based on data from the Keep Well Live2 Business Objects Universe, which is
populated by data extracted from Keep Well practices, using the SCI-DC platform. This process is
managed by NHS Tayside. The number of health checks represented in this report is 1420 (79% of
the total 1795 delivered). The difference in health check numbers is due to technical issues with SCI-
DC and also because not all practices in NHS Grampian are signed up to the Local Enhanced Service
Contract which enables data extraction. It is believed that the data set of 1420 health checks is a
representative sample of the total health checks. The number of practices represented in this data,
per CHP is: Aberdeen City 23, Aberdeenshire 9, and Moray 2. We are working with NHS Tayside to
include data from all practices participating in Keep Well so that reporting for 2013/14 is more
comprehensive.
Reach and attendance
The tables below show the number of patients invited, number attended, and % attended, by a
range of variables eg age, gender, SIMD, CHP.
Age - of the 4477 patients invited: 464 (10%) were under 40; 2204 (49%) were 40<50; 1809 (40%)
were 50-64. The table below shows that overall, 32% of patients who were invited received a health
check. The youngest age group had a higher uptake percentage compared to the other age groups;
this is a reverse of the findings of last year, and may reflect the continuing work in offering health
checks to vulnerable groups.
Invited Attended
Age No No % of
invited
Under 40 464 212 46%
40<50 2204 607 28%
50-64 1809 601 33%
Grand Total 4477 1420 32%
Gender – of the 4477 patients invited: 53% were male; 47% were female. Females were more likely to take up the offer of a health check (35% of invited females attended a health check).
Invited Attended
Gender No No % of
invited
Male 2362 676 29%
Female 2115 744 35%
Grand Total 4477 1420 32%
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SIMD 2009 Quintile – of the 4477 patients invited, 1844 were from the most deprived quintile 1, and 1668 from quintile 2. This means that 78% were from the most deprived quintiles 1 & 2, thus illustrating that targeting has been effective. The uptake % among quintile 1 (most deprived) patients was lower than for other quintiles
Invited Attended
SIMD 2009 Quintile No No % of
invited
1 - most deprived 1844 500 27%
2 1668 573 34%
3 573 201 35%
4 124 48 39%
5 - least deprived 216 74 34%
Unassigned 52 24 46%
Grand Total 4477 1420 32%
Carers – 93 carers were invited for a health check, and 75 attended (81%) indicating a higher than average uptake rate. However, it may be that the numbers invited are under-reported in this data set because the information on carers invited through carer health check initiatives at, for example, Aberdeen Health and Care Village, (but who did not attend) may not have been recorded in GP practice systems.
Invited Attended
Carers No No % of invited
Grand Total 93 75 81%
Homeless – the majority of health checks for homeless persons are delivered in the homeless practice in Aberdeen City. The table below illustrates that the practice was able to provide health checks to the majority of patients invited.
Homeless practice Invited Attended
Age No No % of invited
Under 40 31 18 58%
40<50 15 8 53%
50-64 2 0 0%
Grand Total 48 26 54%
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Keep Well 2013-14 NHS Grampian
Ethnic Groups – 541 members of the two identified ethnic vulnerable groups were invited for a health check, and uptake was higher than the average of 32%, particularly in the South Asian group.
Invited Attended
Ethnic Vulnerable Group No No % of invited
Black Afro Caribbean 335 115 34%
South Asian 206 89 43%
Grand Total 541 204 38%
Invitation Method – the table below shows that whilst invitation by ‘letter only’ was by far the most common method, it appears to be the least effective. Patients who were invited verbally or by phone were much more likely to attend a health check.
Invited Attended
Method of Invitation No No % of
invited
Letter only 3021 807 27%
Letter & verbal/phone 966 245 25%
Verbal/phone no letter 262 174 66%
Method unrecorded 228 194 85%
Grand Total 4477 1420 32%
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Keep Well 2013-14 NHS Grampian
Health checks – demographic data
The charts below illustrate the number of patients receiving a health check, by a range of variables
eg age, gender, SIMD. The analysis is based on 1420 health checks.
Age – compared to 2012-13, a greater proportion of health checks were delivered to the Under 40
age group (15% compared to 7%). This reflects increased delivery to vulnerable groups (core group is
40-64).
Gender – health checks were fairly evenly split between males and females. Note - from Reach
analysis, above- that more males were invited, but their uptake was lower than females.
Under 40 15%
40<50 43%
50-64 42%
Attended health check, by age group
Male 48%
Female 52%
Attended health check, by gender
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SIMD 2009 Quintiles – 77% of health checks were delivered to patients from the most deprived
quintiles (36% to Quintile 1; 41% to Quintile 2), thus illustrating that our targeting has been effective.
Compared to 2012-13 there was a higher % in the Quintile 3 category; this is because of an increased
number of Quintile 3 patients in Aberdeenshire and Moray, where the eligibility criteria extend to
Quintile 3 smokers. Quintile 5 (least deprived) health checks were patients from vulnerable groups
or those who had been specifically identified as being likely to benefit from a health check.
Employment – the majority of patients receiving a health check were in employment (61%), with
10% unemployed and 8% unfit for work.
Quintile 1 - most deprived
36%
Quintile 2 41%
Quintile 3 14%
Quintile 4 4%
Quintile 5 - least deprived
5%
Attended health check, by SIMD quintile
Employed 61%
Unemployed 10%
Unfit for work 8%
Retired 4%
Housewife/ husband
3%
Student 1%
Status not recorded
13%
Other 17%
Attended health check, by Employment Status
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Health checks – clinical data
Blood Pressure
Out of 1420 health checks, 1228 (86%) had a valid record of blood pressure. The numbers and %s
below refer to the 1228 health checks with a valid record of blood pressure. High blood pressure is
defined as systolic >140 and/or diastolic >90.
Age – older age groups had a higher percentage of patients with high blood pressure, compared to
younger age groups.
BP recorded
BP : systolic > 140 and/or diastolic >90
Age No No % of BP recorded
Under 40 175 12 7%
40<50 529 98 19%
50-64 524 134 26%
Grand Total 1228 244 20%
Gender – percentage of patients with high blood pressure was higher for males.
BP recorded BP : systolic > 140 and/or
diastolic >90
Gender No No % of BP recorded
Male 576 150 26%
Female 652 94 14%
Grand Total 1228 244 20%
SIMD 2009 Quintile – there was no specific trend or gradient in relation to deprivation.
BP recorded BP : systolic > 140 and/or
diastolic >90
SIMD 2009 Quintile No No % of BP recorded
1 - most deprived 429 88 21%
2 496 108 22%
3 192 28 15%
4 37 10 27%
5 - least deprived 59 6 10%
Unassigned 15 4 27%
Grand Total 1228 244 20%
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CHP – the percentage of patients with high blood pressure (140/90 or higher) in Moray (33%)
appears much greater than the average of 20%. However, it should be noted that the % is based on a
relatively small (58) number of patients.
BP recorded
BP : systolic > 140 and/or diastolic >90
Age No No % of BP recorded
Aberdeen City 904 174 19%
Aberdeenshire 266 51 19%
Moray 58 19 33%
Grand Total 1228 244 20%
Total Cholesterol
Out of 1420 health checks, 1185 (83%) had a valid record of total cholesterol. The numbers and %s
below refer to the 1185 health checks with a valid record of cholesterol.
Age – the percentage of patients with high cholesterol increases with age.
Total cholesterol recorded
Cholesterol >5
Age No No % of total
Under 40 163 56 34%
40<50 519 270 52%
50-64 503 311 62%
Grand Total 1185 637 54%
Gender – the percentage of males and females with high cholesterol (>5) was similar.
Total cholesterol recorded
Cholesterol >5
Gender No No % of total
Male 559 292 52%
Female 626 345 55%
Grand Total 1185 637 54%
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SIMD 2009 Quintile –the percentages with high cholesterol (>5) were fairly similar across the
quintiles.
Total cholesterol recorded
Cholesterol >5
SIMD 2009 Quintile No No % of total
1 - most deprived 418 223 53%
2 482 266 55%
3 165 88 53%
4 38 20 53%
5 - least deprived 65 31 48%
Unassigned 17 9 53%
Grand Total 1185 637 54%
CHP – it appears that Aberdeen City had a lower percentage of patients with high cholesterol (>5)
when compared to the other two CHPs.
Total cholesterol recorded
Cholesterol >5
Age No No % of total
Aberdeen City 921 483 52%
Aberdeenshire 203 115 57%
Moray 61 39 64%
Grand Total 1185 637 54%
ASSIGN CVD Risk Score
A key component of the Keep Well health check is the ASSIGN CVD risk score.
Out of 1420 health checks, 843 (59%) had an ASSIGN score recorded. The numbers and %s below
refer to the 843 health checks with a valid record of ASSIGN score. It might be argued that this data
may not represent the true situation regarding the ASSIGN scores in the Keep Well population and
therefore some analysis was carried out to check that argument. A separate data analysis was
carried out; including only those practices where the percentage of health checks with an ASSIGN
score recorded was high. This analysis showed similar findings to those below, therefore we are
assured that this data is robust.
Potentially, there are two key reasons why recording of ASSIGN score has been so low. One is that it
cannot be recorded at the health check unless the blood test results are available. The other is that it
may not be widely understood that the risk calculator that exists as part of Vision does not
automatically record the score in the patient journal.
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Age – as would be expected, CVD risk >= 20% increased with age. 2% of 40<50 year olds had a high
CVD risk, compared to 19% among the over 50s.
Risk score calculated
Score >= 20%
Age No No % of calculated
Under 40 92 1 1%
40<50 352 7 2%
50-64 399 74 19%
Grand Total 843 82 10%
Gender – males were more likely than females to have a high CVD risk.
Risk score calculated
Score >= 20%
Gender No No % of calculated
Male 402 49 12%
Female 441 33 7%
Grand Total 843 82 10%
SIMD 2009 Quintiles – the numbers per quintile were fairly low, therefore the percentages in the
table below may not be significantly different.
Risk score calculated
Score >= 20%
SIMD 2009 Quintile No No % of calculated
1 - most deprived 273 25 9%
2 347 35 10%
3 147 16 11%
4 19 1 5%
5 - least deprived 43 1 2%
Unassigned 14 4 29%
Grand Total 843 82 10%
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CHP – analysis by CHP suggests that high ASSIGN risk scores were more common among health
checks in Aberdeenshire and Moray, compared to Aberdeen City. However, some care should be
taken in interpreting this data, as the numbers of health checks with a risk score were fairly small in
Aberdeenshire and particularly Moray.
It should also be noted that the eligibility criteria used in Shire and Moray specifically targets
smokers.
Risk score calculated
Score >= 20%
Age No No % of calculated
Aberdeen City 522 34 7%
Aberdeenshire 269 43 16%
Moray 52 5 10%
Grand Total 843 82 10%
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Health checks – lifestyle data
Smoking
Note that this data is influenced by the fact that in Aberdeenshire and Moray, smoking is used as
one of the eligibility criteria.
Out of 1420 health checks, 1280 (90%) had a current smoking status. The numbers and %s below
refer to the 1280 health checks with a current smoking status.
Age – patients in the youngest age group were the least likely to be smokers (34% compared to the
overall % of 40%).
Total: Smoking status
recorded
Non smoker
Ex smoker
Smoker
Age No No No No % of total
Under 40 188 106 18 64 34%
40<50 552 198 120 234 42%
50-64 540 173 155 212 39%
Grand Total 1280 477 293 510 40%
Gender – males and females were equally likely to be smokers.
Total: Smoking status
recorded
Non smoker
Ex smoker
Smoker
Gender No No No No % of total
Male 603 214 145 244 40%
Female 677 263 148 266 39%
Grand Total 1280 477 293 510 40%
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SIMD 2009 quintile and CHP – the data below is heavily influenced by the fact that in Shire and
Moray, quintile and smoking status are used as eligibility criteria.
Total: Smoking status
recorded
Non smoker
Ex smoker
Smoker
SIMD 2009 Quintile No No No No % of total
1 - most deprived 460 172 119 169 37%
2 513 184 115 214 42%
3 177 43 35 99 56%
4 44 25 10 9 20%
5 - least deprived 67 44 10 13 19%
Unassigned 19 9 4 6 32%
Grand Total 1280 477 293 510 40%
Total: Smoking status
recorded
Non smoker
Ex smoker
Smoker
Age No No No No % of total
Aberdeen City 988 453 229 306 31%
Aberdeenshire 237 20 53 164 73%
Moray 55 4 11 40 69%
Grand Total 1280 477 293 510 40%
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Body Mass Index (BMI)
Out of 1420 health checks, 1279 (90%) had a current BMI. The numbers and %s below refer to the
1279 health checks with a current BMI.
Age – the percentage of patients with a BMI of 25+ increased with age.
BMI calculated
BMI 25+
Age No No % of BMI
calculated
Under 40 193 123 64%
40<50 541 363 67%
50-64 545 380 70%
Grand Total 1279 866 68%
Gender – the percentage of patients with a BMI of 25+ was similar for males and females.
BMI calculated
BMI 25+
Gender No No % of BMI
calculated
Male 605 417 69%
Female 674 449 67%
Grand Total 1279 866 68%
SIMD 2009 quintile – given that there were low numbers of patients in the less deprived quintiles,
there does not appear to be a significant difference in the percentage with BMI 25+ across the
quintiles.
BMI calculated
BMI 25+
SIMD 2009 Quintile No No % of BMI
calculated
1 - most deprived 455 332 73%
2 515 323 63%
3 182 121 66%
4 43 35 81%
5 - least deprived 65 42 65%
Unassigned 19 13 68%
Grand Total 1279 866 68%
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CHP – the percentage of patients with a BMI of 25+ appears lower for Moray, although it should be
noted that this is based on low numbers.
BMI calculated
BMI 25+
Age No No % of BMI
calculated
Aberdeen City 977 662 68%
Aberdeenshire 250 173 69%
Moray 52 31 60%
Grand Total 1279 866 68%
Exercise
Out of 1420 health checks, 1205 (85%) had a current exercise/activity status. The numbers and %s
below refer to the 1205 health checks with a current exercise/activity status.
Current guidance for adequate activity levels is ‘at least 30 minutes of moderate activity on at least 5
days a week’. Around one in ten patients stated that they achieved this level of activity; however, it
is possible that this Read code had been under-reported or overlooked. Therefore, the tables below
group the Read codes for ‘Enjoys moderate exercise’, ‘Enjoys heavy exercise’ and/or ‘at least 30
minutes of moderate activity on at least 5 days a week’ into the statement ‘meets current
guidelines’.
Age – As might be expected, activity levels were highest in the youngest age group.
Total: activity level recorded
‘Meets’ current guidance
Age No No % of total
Under 40 187 95 51%
40<50 511 210 41%
50-64 507 175 35%
Grand Total 1205 480 40%
Gender – males were more likely to meet current guidelines than females.
Total: activity level recorded
‘Meets’ current guidance
Gender No No % of total
Male 577 255 44%
Female 628 225 36%
Grand Total 1205 480 40%
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SIMD 2009 quintiles – activity levels across the quintiles were broadly similar.
Total: activity level recorded
‘Meets’ current guidance
SIMD 2009 Quintile No No % of total
1 - most deprived 400 155 39%
2 500 197 39%
3 179 76 42%
4 43 14 33%
5 - least deprived 63 31 49%
Unassigned 20 7 35%
Grand Total 1205 480 40%
CHP – it appears that Aberdeen City patients were more likely to meet current guidance on activity.
Total: activity level recorded
‘Meets’ current guidance
Age No No % of total
Aberdeen City 911 382 42%
Aberdeenshire 237 84 35%
Moray 57 14 25%
Grand Total 1205 480 40%
Jackie Fleming
Keep Well Information Analyst
October 2014