Australian Primary Care Collaboratives

Berwick  Medical Centre   is one  of an  additional   600 general practices across Australia  to have  joined  the Australian  Primary Care   Collaboratives which  commenced  in 2003  with  600 general practices.  The Collaboratives aim  to improve  clinical  outcomes, reduce lifestyle  risk and  maintain  good  health  for patients  with a range of  chronic  conditions as well as  promoting a culture  of quality improvement  within the  practices.

 Practices initially focus on chronic  heart  disease and   diabetes. Some  of the improvements that  have  occurred   within participating  group over the past  3 years are :

 For Coronary Heart Disease   ( CHD )

• 28% improvement  in patients  with CHD  taking  aspirin
• 26% improvement  in patients with CHD taking statins
• 50 % improvement   in patients  with CHD  whose  last recorded  BP  is </= 130/80

For Diabetes

• 97% improvement  in diabetic  patients  having HbA1c  < 7 %
• 132% improvement in diabetic patients with  total cholesterol  < 4 mmol/l
• 101% improvement  in diabetic  patients  whose  last  BP was </=130/80

These results are  significant  when it  is know that  aspirin  reduces the  risk  of a major cardiovascular  episode   like  heart  attack  by 22% within  2 years for a patient  with  demonstrated  vascular  risk like a previous  heart  attack , lowering  cholesterol  has  a 22%  reduction for  relative  risk  of a major  cardiovascular event and lowering BP to target sees a  21% reduction in mortality within a 3 year period

For diabetics there is a 21%  reduction  in  diabetes related causes of death for  every 1%  reduction in HbA1c and  a 14 % reduction in death  from any cause  for each  1% reduction in HbA1C and only  9 % of diabetics  had total cholesterol of  < 4 mmol/l  - if   abnormal cholesterol levels  are  reduced  to <  4 mmol/l then  there  is  a  25%  reduction  in these  diabetic   patients  presenting to hospital  or  the Emergency  department  within  3 years.

Smoking > 1 cig /day  results  in a  10% risk of  CHD  death this  risk  drops to  6%  within  3 months  of cessation of  smoking  and recent  research suggests this  becomes  4% -  the  same risk as  a non smoker  within   3 years of ceasing  smoking.

It is know to   us as  GP’s  that most  patients following heart  attack are  recommended and prescribed  ongoing  medication  including aspirin , statins , ACE inhibitors or   beta blockers  which should  not  be ceased except  on  medical advice as they are known to  reduce the  risk of further major  cardiovascular  events  and patients are  referred  for GP  followup for these  treatments .  However   1/3  of  patients  following  their  heart attack  will cease  some of their  medication without  seeking medical advice  within  12 months  of their  heart attack and        1/8 will cease all their  medication within 12 months   even though  ample  research exists to demonstrate they place themselves in  jeopardy by doing so.

It is for these reasons that  Berwick  Medical Centre has  engaged in the APCC  collaborative and why  we ask you to  cooperate with the  changes this will introduce as it  will result  in proven health benefits to you the patient .