May 2005 CHD Health Equity Audit PRIMIS Fifth Annual Conference 11 – 12 May 2005 Piecing Together the Future Vicky Smith Jane Robinson.

May 2005

CHD Health Equity Audit

PRIMIS

Fifth Annual Conference 11 – 12 May 2005

Piecing Together the Future

Vicky Smith Jane Robinson

May 2005

CHD Health Equity Audit using Primary Care Data

12 May 2005

National PRIMIS Conference

Vicky Smith, Acting Primary Care Information Manager (GPPCP)

Jane Robinson, Senior Public Health Information Specialist (ASP)

May 2005

What is a Health Equity Audit?

“The purpose of HEA is to help services narrow health inequalities by using evidence to inform decisions on investment, service planning, commissioning and delivery and to review the impact of action on inequalities.”

May 2005

HEA’s

• Identifies how fairly services or other resources are distributed

• Help to provide services based on relative need

• Distribute resources relative to health need

May 2005

HEA is a cycle

• It is not just a review of services

• Approximately a three year cycle

• The cycle is not completed until something changes which is likely to reduce inequalities

May 2005HEA Cycle

Use data on health inequalities toSupport decisions at all levels

1. Agree partners and issues

2. Equity profile: identify the gap

3. Agree high impact local action to narrow the gap4. Agree

priorities for action

5. Secure changes in investment & local delivery

6. Review progress & assess impact

May 2005

Process at Greater Peterborough Primary Care Partnership

• Decide on area to audit (previous audits, knowledge of health needs of area)

• Established what parameters we would like to look at• Director of Public Health and Primary care information manager

wrote a joint letter to GP practices explaining process• Primary care information team wrote and tested report style

MIQUEST Queries• Data collected from ALL (33) practices in GPPCP• Response disks handed over to PH information lead to analyse• Data quality analysed• Data analysed against various variables• Draft report currently being written

May 2005

Why Heart Disease?• Biggest killer for both PCTs• Known high incidence in high ethnic minority areas

and deprived areas• CHD NSF• Impact of PRIMIS• Impact of nGMS• Increased commissioned CABGs and PCTAs

several years ago and wanted to know if it was having an effect

• We knew that the data would be robust enough to analyse

May 2005

What we wanted to look at

• Risk factors for IHD – smoking, diabetes, exercise status, BMI

• Prevention – exercise schemes and advice, health eating schemes, access to open spaces

• Primary care – diagnosis and prevention treatment

• Secondary care – hospital activity• Deaths

May 2005

Health Data Items collected• Postcode• Practice ID• Age and gender• Ethnicity• Ischemic heart disease• Diabetes• Hypertension• Hyperlipideamia• Smoking status• BMI• Blood pressure• Exercise status• Aspirin

• Cholesterol

• Statin’s

• Cardiac rehabilitation

• Advice on smoking and exercise

• Non elective admissions to hospital for IHD

• CABGS, PCTAs procedures

• Death from IHD

• Deaths attributable to smoking

May 2005

MIQUEST Queries

• Looked at Report style queries for RUSH for practices

• These were edited to meet our needs

• Read Codes were based on nGMS contract business rules and PRIMIS queries

May 2005

Collection process• Made appointment to visit practice• Wrote query disks using MIQUEST Query

Manager (local queries)• Visited practices and ran local MIQUEST

queries• Saved responses to floppy disk• Checked responses before leaving practice• Returned disks to HQ and handed over to PH

Analyst

May 2005

Potential pitfalls• Need to access ALL practices• Time to write three query sets (Vision 5 byte,

Torex 4 byte and EMIS 5 byte)• Time to collect data (33 practices)• Technical problems with systems at some

practices• Need to check response disk before leaving

practice

May 2005

Analysing data – primary careIHD Prevalence: Percentage across GPPCP

0

1

2

3

4

5

6

30

80

2

30

80

3

30

80

4

30

80

5

30

80

6

30

80

7

30

80

8

30

80

9

30

81

0

30

811

30

81

2

30

81

3

30

81

4

30

81

5

30

81

6

30

85

3

30

85

4

30

85

5

30

85

6

30

85

7

30

85

8

30

85

9

30

86

0

30

86

2

30

86

3

30

87

1

30

87

2

30

87

4

30

87

5

30

87

7

30

87

8

Practices

Pe

rce

nta

ge

of

IHD

All Scheme average

May 2005

Analysing data – primary careGreater Peterborough Primary Care Partnership

Ischaemic Heart Disease prevalence by electoral ward

0

5

10

15

20

25

30

35

40

45

50

Bar

nack

Nor

thbo

roug

h

Ben

wic

k C

oate

s an

d E

astr

ea

St

And

rew

s

Bar

nwel

l

Kin

gsm

oor

Low

er N

ene

Del

ph

Bas

senh

ally

Stil

ton

St

Mar

ys

Glin

ton

and

Witt

erin

g

Wes

t

Kin

g's

For

est

Latt

erse

y

Sta

ngro

und

Cen

tral

Sta

ngro

und

Eas

t

Par

k

Pre

bend

al

Oun

dle

Wer

ringt

on S

outh

New

boro

ugh

Elto

n an

d F

olks

wor

th

Bre

tton

Sou

th

Yax

ley

and

Far

cet

Wal

ton

Wer

ringt

on N

orth

Rav

enst

horp

e

Nor

th

Dog

stho

rpe

Fle

tton

Eas

t

Eye

and

Tho

rney

Pas

ton

Ort

on W

ater

ville

Cen

tral

Ort

on w

ith H

ampt

on

Bre

tton

Nor

th

Ort

on L

ongu

evill

e

Electoral ward

Rat

e p

er 1

,000

PCP rate = 25.72

Source: HEA Audit, Autumn 2004

May 2005

Analysing data – primary careGreater Peterborough Primary Care Partnership

Ischaemic Heart Disease and 2004 IMD

R2 = 0.282

0

5

10

15

20

25

30

35

40

45

0 5 10 15 20 25 30 35 40 45 50

IMD Score

IHD

Pre

va

len

ce

, ra

te p

er

1,0

00

Source: HEA Audit, Autumn 2004

May 2005

Analysing data – secondary careGreater Peterborough Primary Care Partnership

Non Elective admissions for Ischaemic Heart Disease by Electoral Ward, 2002/03 - 2004/05

-1

0

1

2

3

4

5

6

7

8

Nor

thbo

roug

h

Bar

nack

Low

er N

ene

Stil

ton

Glin

ton

and

Witt

erin

g

Kin

g's

For

est

Bar

nwel

l

Ben

wic

k C

oate

s an

d E

astr

ea

Oun

dle

Elto

n an

d F

olks

wor

th

Bre

tton

Sou

th

New

boro

ugh

St M

arys

Pre

bend

al

Wer

ringt

on S

outh

Wes

t

Yax

ley

and

Far

cet

Ort

on L

ongu

evill

e

St A

ndre

ws

Par

k

Ort

on W

ater

ville

Eye

and

Tho

rney

Sta

ngro

und

Eas

t

Sta

ngro

und

Cen

tral

Wer

ringt

on N

orth

Latte

rsey

Pas

ton

Wal

ton

Bas

senh

ally

Del

ph

Ort

on w

ith H

ampt

on

Bre

tton

Nor

th

Rav

enst

horp

e

Fle

tton

Dog

stho

rpe

Nor

th

Eas

t

Kin

gsm

oor

Cen

tral

Electoral Ward

Rat

e p

er 1

,000

Source: HEA Audit, Autumn 2004

PCP rate = 3.21

May 2005

Analysing data – secondary careGreater Peterborough Primary Care Partnership

Non Elective Admissions to 2004 IMD

R2 = 0.4605

0

1

2

3

4

5

6

7

0 5 10 15 20 25 30 35 40 45 50

2004 IMD

AS

R N

on

Ele

ctiv

e ad

mis

sio

ns

per

1,0

00

Source: HEA Audit, Autumn 2004

May 2005

Analysing data – deathsGreater Peterborough Primary Care Trust

Death from IHD (1997-2003) by electoral ward

-50

0

50

100

150

200

250

300

350

Pre

bend

al

Low

er N

ene

Oun

dle

Bar

nwel

l

Bre

tton

Glin

ton

and

Kin

g's

For

est

Wes

t

Bar

nack

Ort

on w

ith

Elto

n an

d

Ort

on

Wer

ringt

on

Del

ph

Yax

ley

and

Wal

ton

Sta

ngro

und

Nor

thbo

roug

h

Wer

ringt

on

Sta

ngro

und

Eye

and

New

boro

ugh

Stil

ton

Par

k

Bas

senh

ally

Kin

gsm

oor

Pas

ton

Ort

on

Ben

wic

k

Eas

t

Bre

tton

Nor

th

Latt

erse

y

St

And

rew

s

Fle

tton

Dog

stho

rpe

Nor

th

Rav

enst

horp

e

St

Mar

ys

Cen

tral

Electoral ward

Rat

e p

er 1

00,0

00

Source: ONS deaths data

PCP rate = 145.42

Work in progress – conversion ratios for change in coding not yet performed

May 2005

Analysing data – deathsGreater Peterborough Primary Care Partnership

Deaths from IHD (1997 - 2003) and 2004 IMD

R2 = 0.4209

0

50

100

150

200

250

300

0 5 10 15 20 25 30 35 40 45 50

2004 IMD

Dea

th r

ate

per

100

,000

Source: HEA Audit, Autumn 2004Work in progress – conversion ratios for change in coding not yet performed

May 2005

Analysing data – deathsGreater Peterborough Primary Care Partnership

Non Elective Admissions to Deaths

R2 = 0.3262

0

1

2

3

4

5

6

7

0 50 100 150 200 250 300

Death rate per 100,000

No

n E

lect

ive

adm

issi

on

s ra

te p

er 1

,000

Source: HEA Audit, Autumn 2004Work in progress – conversion ratios for change in coding not yet performed

May 2005

Potential pitfalls• Too many variables: length of time to

perform initial profile• “activity” for wards on the boundary

probably not complete – only collected data for PCP GPs (deaths for whole ward)

• Data quality issues – not regularly collected items– Ethnicity 35% recorded– Exercise status 57% recorded– Exercise advice 30% recorded

May 2005

Ethnicity coding by practiceGreater Peterborough Primary Care Partnership

CHD HEA Ethincity by electoral ward

0

10

20

30

40

50

60

70

80

90

Bar

nwel

l

Kin

gsm

oor

Low

er N

ene

Oun

dle

St

Mar

ys

Ben

wic

k C

oate

s an

d E

astr

ea

Latt

erse

y

Bas

senh

ally

St

And

rew

s

Stil

ton

Pre

bend

al

Del

ph

Yax

ley

and

Far

cet

Kin

g's

For

est

Eye

and

Tho

rney

Elto

n an

d F

olks

wor

th

New

boro

ugh

Glin

ton

and

Witt

erin

g

Sta

ngro

und

Eas

t

Sta

ngro

und

Cen

tral

Bar

nack

Fle

tton

Ort

on W

ater

ville

Ort

on L

ongu

evill

e

Wer

ringt

on S

outh

Wes

t

Ort

on w

ith H

ampt

on

Eas

t

Dog

stho

rpe

Wal

ton

Nor

th

Par

k

Pas

ton

Rav

enst

horp

e

Nor

thbo

roug

h

Wer

ringt

on N

orth

Cen

tral

Bre

tton

Sou

th

Bre

tton

Nor

th

electoral ward

% c

om

ple

tio

n

PCP % = 35.64

May 2005

What next?

• Agree draft report with those involved/ partners• Publish report with agreed actions• Secure changes in investment & local delivery• Complete HEA Self Assessment tool kit• Review progress and assess impact (2006/07)

May 2005

More information

• http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/HealthInequalities/fs/en

• http://www.publichealth.nice.org.uk/page.aspx?o=502511

May 2005

Any questions?

May 2005

Contacts

• Vicky SmithActing Primary Care Information [email protected] 758547

• Jane RobinsonSenior Public Health Information [email protected] 758524

May 2005

Thank you