The following tools, searches and process will help improve lipid management.
The workload involved with lipid management is daunting. This strategy is designed to allow chunking of this work into manageable chunks, depending on the resource available.
The order of the interventions described below is likely to be the most sensible order to tackle the workload.
| Intervention | Workload | Realistic timeframe | Staff | Search | Action | Notes |
| Casefinding – searches to identify relevant uncoded conditions e.g. CKD | Run batch searches at regular intervals e.g. quarterly | 1 month initially Ongoing | GP, NP, pharmacist | Run case finding searches | Review record | These searches also improve QoF payments as these are dependent on disease prevalence |
| Review lipid lowering concordance | Run regular batch searches e.g. monthly | Ongoing | GP, NP, PN, pharmacist | ? Lipids 3.2 | Review record | Contact patients who seem to have stopped their lipid lowering |
| Consider starting lipid lowering in at risk patients | Usually a very large amount of ongoing work | 12-24 months | GP, PN, pharmacist, NP | ? Lipids 3.0 | Review record and consider starting lipid lowering | This very large workload can be broken down into smaller chunks using the searches that subdivide patients into different levels of risk. Cases can be considered during LTC reviews |
| Conduct CVD risk assessments in line with NICE guidance | Usually a very large amount of ongoing work | Ongoing | GP, NP, PN, pharmacist | ? Lipids 1.0 | Consider invitation for CVD risk assessment | This workload can be broken down into smaller chunks using the searches that subdivide people into different risk categories or by performing the risk assessments during LTC reviews |
| Lipid lowering intensification | Usually a significant volume of work | Ongoing | GP, NP, pharmacist | ? Lipids 4.2 ? Lipids 4.3 ? Lipids 4.4 ? Lipids 4.5 | Consider intensification of lipid lowering | See Optimising lipid modification for more detail. Can also be considered during LTC reviews |
| Consider setting individual lipid targets | Very large amount of work | 12-24 months then ongoing | GP, NP, PN, pharmacist | ? Lipids 4.1 | Review record and record lipid target | Activate the opt-in lipid resources so users are prompted to record lipid targets automatically on starting lipid lowering. Can also be considered during LTC reviews. |
| Detection of Familial Hypercholesterolaemia | Usually around 0.5% of the list | 6-12 months | GP, pharmacist, lipid nurse | ? Lipids 2.0 | Review patient and consider need for FH assessment | Likely to need some additional training |
| More specialist lipid management | Very small numbers | 1 month | GP, pharmacist, lipid nurse | ? Lipids 5.1-5.4 | Review records and assess need for specialist lipid lowering therapy | Likely to need some additional training |
* Also likely to help with detection of other uncoded conditions such as LVSD, hypertension, CHD
Adding the searches above to a batch reporting process will ensure that clinicians are alerted to patients who need a review at set intervals.