Category A - Vulnerable Group



SystmOne Practices: Vulnerable Patients – The Role of General Practice during COVID19The BMA have published the following guidance to help support practices in identifying their at risk/vulnerable groups:‘Vulnerable Patients – The Role of General Practice during COVID19’ : The Data Quality team have developed searches to support practices in identifying patients in Category A B (Group 1) & C (Group 4), the reports and information provided below are based on the above guidance.PLEASE NOTE: It is the practices responsibility to review patients identified in Category A, B (Group 1) & C (Group 4) to ensure that the correct cohort of patients are being picked up within the reports. Please contact the Data Quality Team if your practice would like additional reports to be developed to identify other at risk patients within your practice: leedsccg.dataqualityteam@Please ensure that you refer to the ‘Key recommended actions from General Practice’ within the above guidance document and offer further support to those patients in these categories that may also be psychologically vulnerable, isolated and potentially frightened.Table of Contents TOC \o "1-3" \h \z \u Category A - Vulnerable Group PAGEREF _Toc36032081 \h 2Category B - At Very High Risk (Groups 1-3) PAGEREF _Toc36032082 \h 2Category C - (Group 4) PAGEREF _Toc36032083 \h 3Practice Contact Actions PAGEREF _Toc36032084 \h 5Category A - Vulnerable Group Patient Group: -Aged 70 or older (regardless of medical conditions)- Aged under 70 with an underlying health condition (i.e. anyone advised to get a flu jab as an adult each year on medical grounds) Reporting> Clinical Reporting > Leeds Data Quality > COVID19 > Cat A I Vulnerable Group I Practice To Review Action Required: -Review patients identified in the ‘Cat A I Vulnerable Group I Practice To Review’ folder- Add the following code to those felt to be at very high risk ‘High risk category for developing complications from COVID-19 infection’ (Y228a). Please, note this will remove the patient from this report and they will be added to your practice contact list. -NOTE: Refer to the ‘Cat A Registers’ report for full patient count Category B - At Very High Risk (Group 1) Patient Group: People with a solid organ transplant such as a kidney or liver transplant ? People with specific cancers ? People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer -People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment - People having immunotherapy or other continuing antibody treatments for cancer - People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors. - People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs. ? People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. See below. ? People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell) ? People on immunosuppression therapies sufficient to significantly increase risk of infection ? People who are pregnant with significant congenital heart disease ? All patients on the following medications: Azathioprine, Mycophenolate (both types), Cyclosporin, Sirolimus, Tacrolimus. Reporting> Clinical Reporting > Leeds Data Quality > COVID19 > B At Very High Risk Groups 1 to 3 Patients in the category B will receive a letter from NHS Business Services or from theirhospital specialist department advising that they take action (shield). General practices arenot asked to proactively contact these patients but it is quite possible that the patientsthemselves may contact their GP surgery for further advice after they receive the NHSBusiness Services letter.Action Required:-Review patients identified in ‘Cat B (Group 1 to 3) Very High Risk’ for accuracy. -Support may be required for patient that have significant dementia, a learning disability or autism,; this may include proactively contacting the patient or as appropriate carer. Please also consider additional support for other vulnerable patient groups within your practice. Thesepatients will be highlighted in GP IT systems as “Covid-19 high risk”.Category C - (Group 4)Patient Group:? Patients with diabetes with HbA1c greater than 75, recent diabetic ketoacidosis or poor medication adherence; ? Patients with Chronic Obstructive Pulmonary Disease (COPD) who have required hospitalisation in the last 12 months or patients who have required 2 or more courses of steroids and/or antibiotics in the last 12 months; ? Patients with asthma with a history of hospitalisation in the last 12 months or ever been admitted to intensive care; ? Patients with significant heart failure which has required hospitalisation for their heart failure within the last 12 months; ? Patients with multiple long-term conditions; ? Patients who have had a splenectomy; ? Patients taking continuous oral corticosteroids of the equivalent of 20 mg of prednisolone or more for over 4 weeks; ? Patients taking immunosuppressive or immunomodulating medication such as ciclosporine, cyclophosphamide, azathioprine, leflunomide, methotrexate, mycophenolate. It is expected that patients taking these medications will be under a shared-care protocol with hospital specialist colleagues and a risk stratification approach should be taken. Advice can be sought from the relevant specialist. Guidance is available from the British Society of Rheumatology ? Other patients that the general practitioner considers would be at high risk such as patients with severe dementia, cognitive impairment. Reporting> Clinical Reporting > Leeds Data Quality > COVID19 > Cat C (Group4) Additional Risk I Practice to Rev Action Required:-Review patients identified in the ‘Cat C (Group4) Additional Risk I Practice to Rev’ folder- Add the following code to those felt to be at very high risk ‘High risk category for developing complications from COVID-19 infection’ (Y228a). Please, note this will remove the patient from this report and they will be added to your practice contact list. -NOTE: Refer to the ‘Cat C Registers’ report for full patient count Practice Contact ActionsReporting> Clinical Reporting > Leeds Data Quality > COVID19 > Contact *All patients at RISK NHSE coded Only-FOR INFO: Patients identified in this report has been automatically added to the ‘At Risk Group’ and will receive a letter from NHS Business Services or from their hospital specialist department advising that they take action (shield).*Patients that have been identified by the Practice as being HIGH RISK (Practice to contact)-Patients identified in this report have been reviewed by the practice and had the ‘High risk category for developing complications from COVID-19 infection’ (Y228a) code added to their record. -These patients need to be contacted by the practice.-Support may be required for patient that have significant dementia, a learning disability or autism,; this may include proactively contacting the patient or as appropriate carer. Please also consider additional support for other vulnerable patient groups within your practice. ................
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