Mid and South Essex
Hypertension Perfect Programme
In partnership with Mid and South Essex NHS Foundation Trust and
ECLIPSE (Equality of Care Led Insights for Patient Safety & Engagement)
Practice Pro-Forma
Project overview:
Cardiovascular Disease (CVD) causes a quarter of all deaths in the UK and is a major driver of health inequalities, accounting for a quarter of the life expectancy gap between deprived and affluent communities. Around 30% of people with hypertension are unaware of their condition, and pre-pandemic Quality and Outcomes Framework (QOF) data showed that around 1/3 of people with diagnosed hypertension are not treated to target, with substantial variation across the country.
The programme aims to identify and engage with patients:
To ensure that patients with coded hypertension have an up-to-date blood pressure (within 12 months).
To ensure that patients with coded hypertension and a blood pressure above their age-appropriate treatment threshold are monitored, reviewed, and optimised.
There are two tiers of support on offer to improve these metrics for practices:
Eclipse Detect – Activation of this programme will activate the Hypertension Perfect pathway within Eclipse, providing a list of all eligible patients, alongside additional priority groups, which can be further filtered and prioritised by parameters such as levels of deprivation, ethnicity, comorbidities, and risk.
Eclipse Complete – Activation of this programme will automatically engage with prioritised patients via the PEGASUS platform to inform, educate, and invite patients to provide an updated blood pressure via an online questionnaire. If desired, telephone patient engagement to non-responders can be activated to allow a team of motivational interviewers to contact your patients to complete the questionnaire. Patient consent and preferences will be captured within Eclipse and prompt follow-up action aligned with this. This could include an up-to-date blood pressure being obtained by the practice or community pharmacy, or the arrangement of home blood pressure testing. A summary patient report can be generated for patients containing the relevant data and any suggested follow-up management considerations.
COHORTS:
The system enables identification of patient cohorts eligible for the programme, such as:
Aged 18 and over, coded with hypertension, who have not had a blood pressure in the last 12 months.
Aged 18-79, coded with hypertension, with an up-to-date blood pressure >140/90.
Aged >=80, coded with hypertension, with an up-to-date blood pressure >150/90.
These priority groups can be further filtered and prioritised by parameters such as levels of deprivation, ethnicity, comorbidities, and risk.
EVALUATION: As well as quantitative data, which will be collected via Eclipse, patient reported outcomes and perceptions of the new pathway will be collected through patient questionnaires.
If your practice would like to take part: Please complete the below pro forma, expressing your interest and permissions for patient engagement.
Please note that you will be notified prior to any active patient engagement, and your practice will be issued with a guide on how to view patient lists and document patient reviews.