Improving cardiovascular disease using managed networks in general practice: an observational study in inner London.
BACKGROUND
System redesign is described in one primary care trust (PCT)/clinical commissioning group (CCG) resulting in improved cardiovascular disease (CVD) management.


OBJECTIVE
To evaluate CVD managed practice networks in one entire local health economy using practice networks, compared with PCTs in London, England, and local PCTs.


METHODS
Observational study of 34 general practices in Tower Hamlets, a socially disadvantaged inner-London borough.


METHODS
In 2009, all 34 practices were allocated to eight geographical networks of four to five practices, each serving 30 000-50 000 patients. Each network had a network manager, administrative support, and an educational budget to deliver financially-incentivised attainment targets in four care packages of which CVD comprised one.


RESULTS
In 2009/11, Tower Hamlets increased total statin prescribing (ADQ-STAR PU) by 17.9% compared with 5.5% in England (P<0.001). Key CVD indicators improved faster in Tower Hamlets than in England, London, or local PCTs, and in 2012/13, Tower Hamlets ranked top in the national Quality and Outcomes Framework for blood pressure and cholesterol control in coronary heart disease (CHD) and diabetes, top five for stroke and top in London for all these measures. Male mortality from CHD was fourth highest in England in 2008 and reduced more than any other PCT in the next 3 years; reducing by 43% compared with an average fall of 25% for the top 10 PCTs in 2008 ranked by mortality.


CONCLUSIONS
Managed geographical practice networks delivered a step-change in key CVD performance indicators in comparison with England, London, or similar PCT/CCGs.
Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
John
J
Robson
Sally
S
Hull
Rohini
R
Mathur
Kambiz
K
Boomla
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000628:therapy*; D019058:Community Networks / Q000458:organization & administration*; D005260:Female; D058006:General Practice / Q000458:organization & administration*; D006801:Humans; D008131:London; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration; D008875:Middle Aged; D011203:Poverty; D058996:Quality Improvement; D013222:State Medicine / Q000458:organization & administration*; D014505:Urban Population
cardiovascular diseases; clinical decision support systems; disease management; general practice; health services; prescribing patterns