Screening not helping at-risk patients - GP

HEATHER SIMPSON
Last updated 10:58 15/07/2014

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Cardiovascular screening of patients is a number-catching exercise and is not improving health outcomes among high-risk groups, a Blenheim doctor says.

Redwoodtown GP Jim Vause said the checks calculated the risk of heart problems instead of improving a patient's heart health.

Vause was speaking at a Marlborough Primary Health Organisation meeting, where he called for a specialised interventional cardiovascular programme to be set up.

In Marlborough, 1894 high-needs patients are eligible for a risk assessment and 1380 patients have received an assessment in the past five years, according to PHO figures. Of those at risk, about 6 per cent had a risk greater than or equal to 20 per cent.

Cardiovascular risk assessment measurements take into account a patient's age, gender, ethnicity, blood pressure, cholesterol, blood glucose levels, smoking status, family history risk factors and past medical history of cardiovascular disease.

The Ministry of Health has set a target for more heart checks in all PHOs, but Danish research detailed in a Cochrane Review revealed that such assessments were a "waste of time", Vause said

"Nurses and doctors are loath to do tests and don't see value in it," Vause said. "Cardiovascular disease assessments are measuring risk, not health outcomes."

Vause said it was "not the fault of the PHO", as the risk assessments were a national target set by the Health Ministry.

Data were sent to the ministry but there were no processes or methodologies for GP practices to improve a patient's health.

Between January and March this year, 5014 risk assessments were carried out in Marlborough. PHO figures showed 334 assessments were carried out on Maori and 53 on Pacific Islanders.

Assessments often missed high-risk groups including Maori and smokers, Vause said, and there was a significant gap between policy and the good of the patient.

"I am embarrassed telling these skinny buggers what to eat when it's the big fella I want to get at. The ministry has to support the concept of health outcomes rather than number-catching."

Vause said there was a disparity between PHO and GP practice data on those at cardiovascular risk.

"We want thorough data. I know people that had a prescription a year ago for heart pills and they are supposed to get them every three months."

GP Kirsten Tucker agreed that cardiovascular risk status was for the benefit of a computer screen.

"We are not changing people's health," Tucker said.

The PHO's chief executive, Beth Tester, said there could be money for a cardiovascular programme but that funding depended on hitting ministry targets. "There needs to be a culture change," Tester said. "We are identifying risk but it is how we change lifestyles where we have an impact."

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The PHO's clinical governance group will discuss how to improve outcomes as well as a possible intervention programme and how it could be funded.

- Marlborough

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