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Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon
 

Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon

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Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon ...

Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

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    Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon Breakout 2.1 Huntingdon integrated sleep studies service - Dr Malav Bhimpuria – GP Principal , Huntingdon Document Transcript

    • Dr Malav Bhimpuria – GP Principal , Huntingdon. Hunts Care PartnersINTEGRATED SLEEP STUDIESSERVICE• Obstructive Sleep Apnoea Syndrome (OSAS) is common (1% men in UK, up to 30% of obese).• Incidence increasing, awareness and referrals increasing too. Hunts Care Partners 1
    • INTEGRATED SLEEP STUDIESSERVICE Up to 23% of men with T2DM have it. NICE estimate up to 1 million people with undiagnosed OSAS to varying degrees. Risks associated with driving. Cardiovascular risk also: associated with obesity, DM, hypertension, ACS, heart failure, AF and the metabolic syndrome. Hunts Care PartnersINTEGRATED SLEEP STUDIESSERVICE Recent evidence (e.g. Lancet 2009; 337: 82) suggests a direct association between OSAS and CV risk. Repetitive hypoxic state activates the sympathetic nervous system and raises blood pressure, heart rate and CV stress. Impaired vascular endothelial function and platelet activation. Moreover, treatment ameliorates the risk. BJGP 2010:60; 235: CPAP improves BP control and sleepiness scores. Hunts Care Partners 2
    • INTEGRATED SLEEP STUDIESSERVICE HOW DIAGNOSED? GP suspects, patient referred to Sleep Centre (usually Papworth Hospital). Gold standard service. Alconbury and Brampton Surgeries....doing something different. National recognition: GP Enterprise Awards for Innovative Clinical Care 2011, “Practical Commissioning”, Worcestershire CCG, Lincs, London, Enfield, Hounslow, Isle of Man. Local recognition. Hunts Care Partners Hunts Care Partners 3
    • INTEGRATED SLEEP STUDIES SERVICE • August 2009: Alconbury and Brampton introduced a near patient pulse oximetry service to support the diagnosis of sleep apnoea (OSA). • “Triple lock”: clinical assessment, Epworth scores and overnight pulse oximetry. • The use of this technology reduced the number of OPFAs at Papworth in year 1 by 60% (20 were tested and of these 8 were then referred to Papworth) and 93% in year 2 (28 were tested and of these only 2 were referred). • People started to notice.... Hunts Care PartnersINTEGRATED SLEEP STUDIES SERVICE  THE AIM: “an innovative, patient- centred, integrated sleep studies service across traditional primary and secondary care boundaries”.  A hub (Papworth Hospital), spoke (each market town: Huntingdon, St Neots, St Ives, March, Ramsey) and satellite (other GP surgeries ) service .  Governance & booking provided by Papworth.  Initially for new patients, eventually follow-ups and then farther a field.  Showcase for the country. Hunts Care Partners 4
    • INTEGRATED SLEEP STUDIES SERVICE • Tariff unbundled: savings for local health economy. • Local incentive for the spoke practices (no new work for no new money). • Satellite surgeries have no increased workload. • Training in primary care for spokes. • Greater awareness across all primary care. • Fewer patient journeys and care closer to home. • Joint working between local commissioners, primary and secondary care. • Involvement of voluntary organisations (BLF). Hunts Care Partners INTEGRATED SLEEP STUDIES SERVICE  RESULTS SO FAR....  All five spokes up and running since May 2012.  Data to December end shows 138 community sleep studies were undertaken.  Of these, 43 (32%) had NO further secondary care input. A further 6 were booked directly for in-pt rx.  Savings to the local health economy.  Rapid diagnosis, local environment, proved it works!  National awareness.  Dept of Health and also B.L.F. Hunts Care Partners 5
    • Any Questions? Dr Malav Bhimpuria MB BS BSC (HONS) FRCGP DCH DRCOG PG Cert GP Principal. Hunts Care Partners 6