The CEG team leads research in the effective delivery of primary care in an ethnically diverse, inner city environment. The findings of this research are directly translated back into health practice through the development of clinical guidelines, risk scores and software tools.
There are three key strands to CEG research:
1. Health inequalities
The Tower Hamlets Health Equity Project, 2007-11, targeted three long-term conditions (coronary heart disease, diabetes and COPD) over three years in order to assess the impact of gender, age and ethnicity on service provision and disease outcomes in Tower Hamlets. It also considered the provision and effectiveness of self-management programmes for chronic disease.
Developing reliable methods of recording ethnicity at general practice level is an essential first stage in identifying disparities in service provision and developing local health policy for ethnically diverse populations. In April 2005 CEG extended data-entry templates for routine recording of self-reported ethnicity to the entire general practice population of three east London PCTs – Tower Hamlets, Newham, and City & Hackney.
Between the 2005 and 2010, total ethnicity recording in east London has increased from 38% to 80%. Recording levels on chronic disease registered have reached a plateau at values of 98%. The scheme now covers almost 150 practices and over 800,000 patients, and forms the basis of much of CEG’s research and guidelines.
CEG has worked with partners at Barts and the London Renal Centre to identify differences by ethnicity in prevalence, progression and management of Chronic Kidney Disease in hypertensive and diabetic populations in east London.
2. Chronic disease management in Primary Care
Atrial fibrillation (AF) is a major cause of stroke. It affects 1 in 20 people over 65 and around 1 in 5 people over 80. Warfarin is the anticoagulant of first choice for AF: it is three times more effective than aspirin. However, in Newham, Tower Hamlets and Hackney & City in 2011, just 50% of people were on warfarin, whilst 40% were on aspirin and 1 in 7 on no antithrombotic at all.
CEG has devised a computer tool – the Anticoagulant Programme East London (APEL) – to assist all east London practices in optimising anticoagulation for patients with AF. This tool is supported by clinical guidelines, baseline and ongoing practice audits, and in-practice facilitation. It is currently being rolled out to all practices in Newham, City & Hackney, and Tower Hamlets.
CEG are collaborating with King’s College London to identify people with atrial fibrillation in four London PCTs – Newham, City and Hackney, Tower Hamlets and Lambeth – with a total population of around 1 million patients. This is one of the few studies to report atrial fibrillation and its management by ethnic group.
CEG staff have been involved in the development of the QDScore, a validated diabetes risk score which predicts the risk of developing diabetes in the next 5 - 10 years on the basis of a prospective cohort study, including both social deprivation and ethnicity. In east London, inclusion of QDScore into NHS Checks is now under consideration and the score is already included as part of the local Joint Strategic Needs Assessment in Tower Hamlets.
CEG staff worked with the University of Nottingham to develop the QRisk score identifying the risk of cardiovascular events. The score is the first to take account of ethnic and socioeconomic diversity in England. QRisk is now integrated into all major GP computer systems and is used throughout England and Wales as part of the NHS Health Checks programme aiming to cover 20 million people.
CEG has undertaken a cross-sectional study using data from general practice in three east London PCTs to identify the prevalence, severity and management of local people with Chronic Obstructive Pulmonary Disease (COPD). In collaboration with south London (Guy’s, King’s and Thomas’s), CEG now plans to examine differences in management by ethnicity across east and south London.
3. Improvement in Primary Care
CEG is working with Tower Hamlets PCT and the new clinical commissioning group (CCG) to evaluate the Integrated Care programme which has been in place for the past 3 years. We plan a separate quantitative evaluation of each of the four care packages: Childhood immunisations, COPD, Diabetes and Cardiovascular disease.
CEG guidelines aim to support improvement in primary care by providing recommendations on the diagnosis and management of patients, combining up-to-date national guidance and an understanding of local needs through CEG research.