Leading up to Evidence Live 2016, we will be publishing a series of blog posts highlighting projects, initiatives and innovative ideas from future leaders in evidence based medicine.
Please read on for the second in the series from Charles Badu-Boateng of King’s College London.
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A recent evaluation by the Lambeth Long Term Conditions Delivery Programme in 2012-13 highlighted a number of key barriers to optimising blood pressure control including poor-adherence and untimely titration of medication1. Evidence from Public Health England suggests that better control of current hypertensive patients can save £120 million of NHS and social care spending over 10 years2.
Southwark Clinical Commissioning Group (CCG) Medicines Optimisation Team is currently running a hypertension audit, examining the effectiveness in using virtual clinics to aid primary care clinicians in managing patients with systolic blood pressure over 160 mmHg and/or diastolic blood pressure over 100 mmHg. The Hypertension Virtual Clinic is a clinical session where hypertension specialists and primary care clinicians discuss difficult patient cases. As a final year medical student on my general practice rotation, I had the opportunity to get involved in this scheme. My role involved using a pre-defined search query on the Egton Medical Information System (EMIS) to identify eligible patients registered with our general practice surgery, and present them for discussions at the virtual clinic.
A Pre-clinic individual hypertension action plan was developed for all the identified patients (36 in total), using both local (South East London Area Prescribing Committee) and national (NICE) guidance. This approach allows clinicians to focus on key areas affecting the patient, whilst at the same time ensuring a holistic evidence-based and patient-centred care. It also identified areas of improvement in patient care without the need to involve specialist clinicians. A post-clinic hypertension action plan (following specialist input) was then prepared, coupled with an immediate discussion with the patient to discuss outcomes of the clinic session.
The hypertension virtual clinic offers an efficient and effective alternative to the traditional hospital based outpatient service, helping to break down any real or perceived boundaries between primary and secondary management of hypertension. It reduces the number of inappropriate referrals to secondary care, which improves patient services, as well as saving clinical time with unnecessary referrals and treatments.