reducing inequalities in primary care – where are we? dr bobbie jacobson director
TRANSCRIPT
![Page 1: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/1.jpg)
Reducing Inequalities in Primary
Care – Where are we?
Dr Bobbie JacobsonDirector
www.lho.org.uk
![Page 2: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/2.jpg)
What will this presentation cover?
• What basics do we need?
• What are we trying to achieve?
• Which inequalities are we looking at?
•What action can we take?
![Page 3: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/3.jpg)
Primary Care – what basics do we need?
• Spearhead PCT?• >30% ethnic minority population• Under-served by GPs• Under-served by non-medical primary care
staff• >10,000 residents not registered with a GP• High numbers of avoidable admissions
![Page 4: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/4.jpg)
Primary Care – what basics do we need?
![Page 5: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/5.jpg)
Primary Care Quality – Admission rates for Asthma and Diabetes
![Page 6: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/6.jpg)
What are we trying to achieve? The life expectancy inequalities target
Starting with Local Authorities, by 2010 to reduce by at least 10% the gap in life expectancy between the fifth of areas with the “worst health and deprivation indicators” and the population as a whole (England).
The areas covered by the target are known as the Spearhead Group.
The baseline is 1995-97.
![Page 7: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/7.jpg)
The spearhead group of Local Authorities
• Those In the worst 20% for 3 or more of the following indicators:– Male life expectancy– Female life expectancy– Cancer mortality in under 75s– Cardiovascular disease mortality in under 75s– Multiple deprivation score
• Covers 70 Local Authorities in England
![Page 8: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/8.jpg)
The spearhead group (London)
![Page 9: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/9.jpg)
Which inequalites? Tower Hamlets Health Profile
![Page 10: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/10.jpg)
Tower Hamlets Health Profile
![Page 11: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/11.jpg)
GP practice profiles – Tower Hamlets
Diabetes
Practice PCT London Statistic
value value value
Diabetes prevalence (all ages) (QOF) 7.4 4.2 3.6 %Diabetes ratio of QOF to estimated prevalence 147.6 85.0 77.2 RatioBMI recorded in last 15 months (DM2) 97.8 94.1 94.5 %HbA1c 10 or less in last 15 months (% of register) 82.6 83.1 83.0 %HbA1c 7.5 or less in last 15 months (% register) 50.9 52.7 55.4 %BP 145/85 or less in last 15 months (% register) 96.9 74.3 72.0 %Chol 5 mmol/l or less last 15 mths (% of register) 79.5 76.4 71.1 %Peripheral pulses recorded in last 15 mths (DM9) 98.6 89.6 89.9 %Neuropathy tested in last 15 months (DM10) 98.6 89.1 89.5 %Micro-albuminuria tested in last 15 mths (DM13) 88.7 40.4 83.0 %Flu vaccine uptake (DM18) 89.3 88.8 88.8 %Retinal screening in last 15 months (DM21) 75.0 72.5 84.1 %eGFR or serum creatinine in last 15 mths (DM22) 95.9 95.6 94.8 %Exception rate for diabetes indicators 2.3 7.3 7.2 %
-5 -3 -2 -1 0 1 2 3 5Worse London Mean Better
![Page 12: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/12.jpg)
Exception rate for COPD indicators
![Page 13: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/13.jpg)
What action can we take? The Health Inequalities intervention
tool• Planning tool to help PCTs and LAs with
local delivery planning and commissioning to reduce inequalities in life expectancy
• Commissioned by Department of Health and produced by LHO and YHPHO for APHO
![Page 14: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/14.jpg)
What does the tool do?• Quantifies the current life expectancy gap
at birth within local authority areas, and between spearhead local authorities and England
• Quantifies the diseases contributing to the life expectancy gap
• Models the effect of four high impact interventions on closing the life expectancy gap
![Page 15: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/15.jpg)
Why use the tool?• There are inequalities in life expectancy within all local areas – spearhead and non-spearhead
• Examples of life expectancy gap between Most Deprived Quintile and Local Authority as a whole in London:– Bromley (non-spearhead) – 4 year difference, 5% gap
(males)– Lewisham (spearhead) – 3 year difference, 4.5% gap
(males)
![Page 16: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/16.jpg)
Understanding the gap• Variations in the top four diseases which make up the within
LA gap across the country
• Key diseases making up the gap in males in two London LA’s (Most Deprived Quintile compared to Least Deprived Quintile):
Bromley (non-spearhead) % Gap Lewisham (spearhead) % Gap
CHD (coronary heart disease) 19 CHD 8
Lung cancer 11 Stroke 9
COPD (chronic obstructive pulmonary disease)
8 Other CVD 9
Other CVD (cardiovascular disease)
7 Other cancers 8
TOTAL 45% 34%
![Page 17: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/17.jpg)
If females in the most deprived quintile had the same mortality rate from stroke as females in the least deprived quintile, they would live 0.4 years longer
![Page 18: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/18.jpg)
Applying evidence- based measures to show impact on the gap
• Interventions included:• Increasing smoking quitters• Improving blood pressure control in people without
diagnosed CVD• Improving blood cholesterol control in people without
diagnosed CVD• Reducing infant mortality
• Modelling of two scenarios:• Applying the interventions across the LA as a whole• Focusing the interventions in the MDQ(Most Deprived
Quintile)
![Page 19: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/19.jpg)
Applying the interventions in the Most Deprived Quintile (MDQ)
• Chart shows the reduction in the within area life expectancy gap in males in Lewisham if the following interventions are applied
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
2000 smoking quitters Smoking quitters + 2000hypertensives treated
Smoking quitters + 2000hypertensives treated + with
statin
1 intervention Combination of interventions
% r
educ
tion
in li
fe e
xpec
tanc
y ga
p
![Page 20: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/20.jpg)
Some Questions• Clarity about which inequalities to address?
• Do local partners agree with me?
• What influence can my service/programme realistically have?
• Is there enough evidence to justify the directions taken?
• How can change be measured?
![Page 21: Reducing Inequalities in Primary Care – Where are we? Dr Bobbie Jacobson Director](https://reader035.vdocument.in/reader035/viewer/2022070410/56649f275503460f94c3fbfa/html5/thumbnails/21.jpg)
Want to know more?
www.lho.org.uk
• Local health profiles: www.healthprofiles.info
• Health inequalities intervention tool: http://www.lho.org.uk/HEALTH_INEQUALITIES/Health_Inequalities_Tool.aspx