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Chronic Disease ManagementChronic Disease Management
Why is this an important issue?High numbers of patients affectedEffective interventions may be availableConcern that there is variation in standards
of care across the countryIn response to this the Government/DoH
has set up some National Service Frameworks
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National Service FrameworksNational Service Frameworks
What are National Service Frameworks?DoH documents/plans but with expert
inputPart of modernisation of NHSProvide standards & service modelsAim to disseminate good practice
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National Service FrameworksNational Service Frameworks
Aim to ensure nationwide access to consistent, good standards of care
Evidence-basedE.g. CHD, Elderly, Mental HealthMore to come
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National Service Framework National Service Framework for Coronary Heart Diseasefor Coronary Heart Disease
10 year programme published by the government in 2000
Sets out 12 national standards for prevention and treatment of CHD
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National Service Framework National Service Framework for Coronary Heart Diseasefor Coronary Heart Disease
Recommends service delivery modelsGives milestones to mark progressLays down audit requirements
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The 12 standardsThe 12 standards
1 & 2: Reducing heart disease in the population, reducing smoking
3 & 4: Preventing CHD in high-risk groups5,6 & 7: Heart attacks and other acute
coronary symptoms
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The 12 standardsThe 12 standards
8: Stable angina9 & 10: Revascularisation11: Heart failure12: Cardiac rehabilitation
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NSF requirements forNSF requirements for primary care primary care
All relevant but perhaps especially -Standards 1 & 2: Reducing heart disease in the
population, reducing smokingStandards 3 & 4: Preventing CHD in high risk
patientsStandard 11: Management of heart failure
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What is required to make it What is required to make it happen?happen?
A systematic approach to preventive cardiac careClinical protocols for dealing with established
heart diseaseA robust system for identification, management
& recall of patients
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Ensuring qualityEnsuring quality
Structure and process elements of any system
easier to monitor than outcomeOutcome may be years in the futureWill morbidity/mortality be improved?