LTC REVIEWS

Overview

Initial Setup

Getting Started

Sending Invitations

Follow-Up

TABLE OF CONTENTS

• Introduction
  • 1 Register I Diagnosis
  • 1 Register | Recall month
  • 2 Review before
  • 3 For initial review I Asthma only 

Introduction

All of the searches that practices need to use for the Ardens LTC Recall process are found in the following folders:

For QOF and Best Practice navigate to Arden's Ltd > LTC Reviews | QOF and Best Practice

For QOF only navigate to Arden's Ltd > LTC Reviews | QOF only

The process is identical no matter which folder practices choose, the only difference is the number of patients that are invited in dependent on whether practices decide to use QOF Only or QOF & Best Practice.

1 Register I Diagnosis

The searches in this folder show practices how many patients are on each disease register. For QOF Only, this will pull through all of the QOF Registers, whereas for QOF & Best Practice there will be extra searches for the Best Practice conditions, as well as slightly different criteria for the QOF Conditions - e.g. QOF & Best Practice looks at all patients who have a diagnosis of Asthma regardless of age or if they have been prescribed asthma medication.

Click here for a list of all the conditions that are included.

1 Register | Recall month

These searches will give practices an idea of how many patients fall into each month of birth. These searches are for reference and are used in the invite searches. These could be used to get an idea if any months may be busier then others and allow practices to then plan accordingly. 

The 'Chosen month' searches in this folder will show if any patients have chosen the month they wish to come and have their review, outside of their month of birth. For more information on how this is set, please visit this guide.

2 Review before

These searches allow practices to review certain patients and do some housekeeping before invites are sent. These searches should be run regularly and ideally before each months invites have been sent to make sure patients aren't being called in unnecessarily.

The ?Consider if review required in Q1 - Review/default in Q4 but has a recall month within Q1 report is useful to run at the start of a QOF year as this will identify any patients that have recently had their review at the end of the previous QOF year, but have a month or birth in Quarter 1 so would be invited in again soon for their annual reviews. Practices can review these patients and decide if they need to be called in so soon.

The ?Consider if review required, if not then record as default to follow-up 170559008 searches which appear in the QOF & Best Practice folder will show patients who may not need to be invited in. For example the ?Consider if review required, if not then record as default to follow-up 170559008 or asthma resolved - Asthma + no asthma-related drugs prescribed in L12M + no other conditions report will show any patient who has a diagnosis of Asthma but has not had their asthma related medication for over 12 months. As the QOF & Best Practice searches will include these patients to invite, practices may wish to review these and decide if they need following up with a review, or if they no longer have Asthma. If a practice reviews these patients and does not wish to invite them in, then by adding the 'default to follow-up (170559008)' code this will remove them from the invite searches. Alternatively, if these patients no longer have Asthma, then the Asthma resolved code could be added to their notes to completely remove them from this register.

3 For initial review I Asthma only 

These searches can be run before invites are sent and allow practices to just send an online Asthma Questionnaire in bulk to the patients. As they have no other conditions, they won't need an initial appointment to take bloods. If they fill out the questionnaire online, then practices can review these results and decide if they need to call the patient in for a follow-up or not. That way, these searches can potentially reduce unnecessary appointment booking.

The top search, 1 For 1st invite | Has asthma only - Send asthma questionnaire + add 1st invite code - All recall will show all patients at the practice who have Asthma and no other condition regardless of their month of birth, so all could be sent a Questionnaire in one go. Alternatively these patients have also been divided by month of birth, so practices could send these out each month, before sending the rest of the invites for all other conditions.

Once these questionnaires have been sent, it is important to add the code of 'Long term condition care planning invitation' (912641000000104 or XabEd) to these patients, which will also remove them from the main invite searches. For more information on adding this code in bulk, please see this part of the sending invites support article.

The 2 For 2nd invite - Has asthma only - Send asthma questionnaire + add 2nd invite code as 1st invite >2w ago and 3 For 3rd invite - Has asthma only - Send asthma questionnaire + add 3rd invite code as 2nd invite >2w ago can then be used to follow up these patients with another reminder or questionnaire if they have not replied or answered the questionnaire yet. Again, just code the patients with 'Long term condition care planning invitation' (912641000000104 or XabEd) once the reminder has been sent.

The bottom 3 searches can be used to follow up patients who have completed the questionnaire and may need it reviewed further, dependent on the ACT score.

For more information on how to send Questionnaires in SystmOne, please see this article.

NEXT: Sending Invitations