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Recipe Name:

Identifying Home Medication Review candidates: Heart Failure patients who are not on ACE inhibitors

Rationale:

ACE inhibitors reduce mortality and morbidity at any grade of systolic heart failure (NPS News 57), even in patients with asymptomatic disease. A search of electronic records can help identify high-risk patients who may benefit from a medication review. This initiative will assist GPs in improving the quality of their prescribing for heart failure.

Target:

To identify patients who would benefit from a Home Medication Review (DMMR).

CAT Starting Point:

  1. CAT Open - CAT4 view (all reports) loaded
  2. Population Extract Loaded and Extract Pane “Hidden”
    1. Filter Pane open and under the ‘General’ tab ‘Active Patients’ (3x <2 years) selected (this step can be
       omitted if you want to search for all patients).
     

 

 

 

Filter Steps

  • Under the 'Conditions' tab, choose the 'Chronic' tab, and then select 'Heart Failure' under the Cardiovascular section


 

  • Under the 'Medications - Heart' tab, in the“ACE or ARB” category, tick “No”.


 

  • Click 'Recalculate to apply the filter

 

Recipe Steps Reports

  • Hide Filters
  • Select the "Medications" tab
  • Select the "Medications per Patient" tab
  • Click the "with 8+ meds" slice of the graph
  • Click on Export to show the list of patients


 

This list will display those patients diagnosed with Heart Failure who are not on ACE inhibitors, but are on more than 8 other medications.

 

Create a prompt to display in Topbar

 

Remember you need to be in the CAT4 Daily View to be able to create prompts. Other pre-requisites are:

  • Topbar is installed
  • CAT4 is linked to Topbar via Edit/Preferences/Topbar - check here for details: Linking CAT4 to Topbar

 To start CAT4 in the Daily View, click on the 'Daily View' icon in the dashboard:



Once you have applied the filter(s) and displayed the patients of interest as described above, you can create a prompt that will be shown to all clinicians using Topbar if a patient meeting the prompt criteria is opened in their clinical system. The full guide is available at CAT PLUS PROMPTS and a short guide on how to create prompts in CAT4 can be found at  Creating a Prompt in CAT4

To start you have to use the drop-down menu at the bottom of the patient details report and select "Prompt at Consult - Topbar" then click on "Go" to give the new prompt a name.

 


The name you enter is the prompt text displayed in Topbar, so choose a simple but clear name that tells the clinician seeing the prompt what should be done.



 

To Export Patient List to Microsoft Excel:

1.  Click on the “Export Icon”  at the top of the Patient Reidentification window.

2.  Click on “Excel”

3.   Choose a file name and a location to save to (eg. Create a folder C:/ClinicalAudit/CAT Patient FollowUp)

4.  Click “Save”

 

The steps above will produce a list of patients with contact details in MS Excel which can then be used to:

1.   Go back through the individual patient records in the GP Clinical Desktop System (CDS) and update known records

2.  Phone patients to update their record

3.  Produce a mail merge to recall patients for follow up