Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records

Cole, James; Torabi, Payam; Dostal, Isabel; Homer, Kate; Robson, John

doi:10.3399/bjgp18x696605

Cited by 9 publications

(10 citation statements)

References 15 publications

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“…[26][27][28] Better engagement by patients enabled by local design of protocols to fit practices' own populations may have aided this finding in this study. Time-series analysis of a similar but uncontrolled intervention performed in London, showed an acceleration in AF prevalence rate during the intervention, 29 but acceleration seen in the control group of the present study showed how this can be caused by external factors. An earlier randomised controlled trial (RCT) did show a significantly higher rate of new AF detection within an opportunistic screening group.…”

Section: Comparison With Existing Literaturesupporting

confidence: 41%

GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before–after study in UK primary care

et al. 2019

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BackgroundFinancial incentives in the UK such as the Quality and Outcomes Framework (QOF) reward GP surgeries for achievement of nationally defined targets. These have shown mixed results, with weak evidence for some measures, but also possible unintended negative effects.AimTo look at the effects of a local intervention for atrial fibrillation (AF) and hypertension, with surgeries rewarded financially for work, including appointing designated practice leads, attendance at peer review workshops, and producing their own protocols.Design and settingA controlled before–after study comparing surgery performance measures in UK primary care.MethodThis study used published QOF data to analyse changes from baseline in mean scores per surgery relating to AF and hypertension prevalence and management at T1 (12 months) and T2 (24 months) for the intervention group, which consisted of all 58 surgeries in East Lancashire Clinical Commissioning Group (CCG), compared to the control group, which consisted of all other surgeries in north-west England.ResultsThere was a small acceleration between T0 (baseline) and T2 in recorded prevalence of hypertension in the intervention group compared to the controls, difference 0.29% (95% confidence interval [CI] = 0.05 to 0.53), P = 0.017, but AF prevalence did not increase more in the intervention group. Improvement in quality of management of AF was significantly better in the intervention group, difference 3.24% (95% CI = 1.37 to 5.12), P = 0.001.ConclusionThis intervention improved diagnosis rates of hypertension but not AF, though it did improve quality of AF management. It indicates that funded time to develop quality-improvement measures targeted at a local population and involving peer support can engage staff and have the potential to improve quality.

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Section: Comparison With Existing Literaturesupporting

confidence: 41%

GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before–after study in UK primary care

et al. 2019

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“…The size of the atrial fibrillation (AF) registers increased by 9% over 3 years, comprising an additional 790 patients identified with AF across the three CCGs. 24 Over this period aspirin monotherapy (no longer recommended) for AF was reduced by more than half in 3 years, and anticoagulation increased by 15% as patients were switched from aspirin to anticoagulants. East London CCGs now have among the best performance in London for managing AF.…”

Section: Ceg-led Quality Improvement Programmesmentioning

confidence: 99%

Progress in using the electronic health record to improve primary care

2020

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BACKGROUND The seminal work in the 1970s by Geoffrey Rose on population-based strategies for prevention 1 and Julian Tudor Hart on evidence-based anticipatory care 2,3 had a profound influence on primary care and were actively supported by the Royal College of General Practitioners. In 1985 in the East London borough of Tower Hamlets, five GP practices collaborated as the Healthy Eastenders Project to support a basic electronic health record (EHR) system, employing nurses for preventive activities and providing comparative audits of their care. By 1992, with the first wave of general practice computerisation, a single EHR system, Egton Medical Information Systems (EMIS), was deployed across all practices in Tower Hamlets with the neighbouring boroughs of City and Hackney and Newham following closely. The Clinical Effectiveness Group (CEG) began to form a supportive network for implementing and evaluating work on preventive care across the locality. 4 The early system required 'floppy disks' to extract data using Morbidity Information Query and Export Syntax (MIQUEST) with manual transport, usually by bicycle, to the CEG office to collate information from each practice. Although cumbersome, the results were transformative, and for the first time practices could see their own performance and share comparable information with their peers. 4-6 In the early days, the theoretical framework used by the CEG team to translate evidencebased innovation into routine clinical practice was necessarily pragmatic. With increasing experience, two complementary strategies framed the process of change. The first included elements of change management described by Kotter. 7 These included: building the case for change, forming a coalition that includes both clinicians and managers, empowering others to act on the programme by the provision of education, comparative performance data, and quality improvement tools, creating early wins for the programme, and consolidating the new approach into work-as-usual to ensure sustainability. An early example of this approach was engaging all practices to code self-reported ethnicity in the early 1990s. Working in an area where 50% of registered patients are from ethnic minority groups, the importance of understanding inequalities in access to health services Debate & Analysis

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“…In addition, pulse rate is a simple and practical tool for assessment of heart rate by general population [6]. In 2018, James Cole and et al, showed that opportunistic pulse regulating checks using in clinic templates was associated with a significance increase in detecting atrial fibrillation rhythm [7]. However, the reliability and validity of this method of pulse rate control for assessment of heart rhythm can be affected by duration of pulse measurement as well as observer errors.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Face to Face vs. Group Training on Self-pulse Rate taking Ability of Patients

Saadat¹,

Sadeghi²,

Jannatipour³

et al. 2019

ijcp

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Introduction: Determining the rate and regularity of peripheral arterial pulses has a major role in assessing the clinical status of patients with cardiovascular disorders. We compared two training methods on the ability of patients to take their radial pulse rate accurately. Methods: Three-hundred patients were randomly divided into two arms. One arm received individual face-to-face training and the other arm received group training via displaying an animation movie. Immediately after the training and then after 48 hours, the patients were tested by a nurse to find out whether they have learned the correct technique of taking radial pulse rate or not. Results: Immediately after the intervention, 84.9% in face-to-face arm and 81.8% in group training arm were able to correctly count their radial pulse rate (P = 0.536). After 48 hours, 71.7% in face-to-face and 60.8% in group training arm were able to correctly count their radial pulse rate (P = 0.051). Conclusions: Both methods were effective to improve the ability of the patients to count their radial pulse rate correctly though face-to-face method was marginally superior to group training.

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Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records

Cited by 9 publications

References 15 publications

GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before–after study in UK primary care

GP incentives to design hypertension and atrial fibrillation local quality-improvement schemes: a controlled before–after study in UK primary care

Progress in using the electronic health record to improve primary care

Comparison of Face to Face vs. Group Training on Self-pulse Rate taking Ability of Patients

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