| Recall Set | Routine Recall | Targeted Recall |
The recall set is designed to facilitate the process of patient recall for follow-up. The recall set extracts the names and addresses of patients and lists of patients with certain characteristics useful for prioritising recall e.g. no record of cholesterol on computer. The results of this data extraction should not be sent outside the practice because it contains patient sensitive information. The floppy disc used should be treated as confidential in the same way as any other patient sensitive data. The practice can use the spreadsheet provided to analyse the data in house, set their own priorities for patient recall and mail merge the recall letters in a matter of minutes.
When the recall query set is requested or downloaded from this website you get the query set, the Excel spreadsheet for analysing the results, a template Word document and a copy of this document. The practice should customise the Word document by adding its Practice Header and changing the date and text to create its own recall letters for patients, without altering the merge fields.
You can use this system to run routine recall of patients to your clinic or for targeted recall of patients who have not had certain interventions, according to your action plan or a mixture of both.
The recall set relies on blood pressure recording as a useful marker of patient review. This method assumes that practices will run a recall set quarterly to create a list of patients for follow-up in the following quarter. To recall patients simply set the No BP in the last 9 months to the highest priority and these patients will then appear at the top of the list. (This is the default option) Other groups such as those with coexisting diabetes can be excluded to avoid duplication by setting a low priority if they will be recalled to a diabetes clinic. The required group (which will be those whos last BP was done in the same quarter last year or never done at all) can then have letters created through the mail merge. Used quarterly, over the course of a year all CHD patients will be recalled who need to be. Those who are seen by the practice opportunistically or by the hospital will not be called unnecessarily as their BP results from hospital should be added as a matter of routine by the practice or by shared care electronic data exchange. The system thereby helps to reduce inappropriate duplication of recall because of multiple diseases and multiple care providers. With this method it is important that opportunistic BPs are accompanied by a quick review of the other secondary prevention interventions with appropriate action.
Alternatively, practices may wish to use their own procedures for this kind of recall using the Annual Review code in the short CHD template.
Why use BP and not an Annual Review read code?
a) BP is recorded anyway and usually accurately so why add more work by requiring entry of another code?
b) Requiring annual review code entry risks forgetting to add them for hospital visits and generating unnecessary recalls
c) Whats so special about an annual review apart from the fact that some people like things that are easy to count? Care is usually provided in primary care over several consultations not one review, so why get sniffy over whether a patient has had an annual review? Whats important is that the appropriate secondary prevention interventions have all been done at some point over an appropriate time scale. This is what the audit reveals and what the recall set can help to maximise by prioritisation. Calling a consultation an annual review is arbitrary and is no guarantee that relevant care has been given.
This system allows prioritisation of recall and the inclusion or exclusion of specific patient groups in the recall process. For example a practice might wish to specifically focus on CHD patients who are not on aspirin but not want to recall those who also have diabetes because they are already being followed up in the diabetic clinic. The system facilitates this more sophisticated recall.
The general procedure is as follows. The practice either extracts the recall files from the website to a (non-write protected!) floppy disc (recommended method as much faster!) or requests a disc from PCAG. The practice loads the queries (*.HQL files) that generate the data for recall onto the clinical system (either directly into the A: drive of the server or over a network to the C:\share\ directory (for EMIS)) and runs them as usual. The resulting response files are downloaded from the clinical system onto the same disc. This disc is then used in a PC, which has Excel and Word, to create the recall letters. Simply open the Excel spreadsheet that comes with the Miquest files by double clicking on it in Windows Explorer and follow the instructions. (You may need to set the macro protection on your Excel application to allow the running of macros). The Excel macros then help you to analyse, prioritise and generate the list of patients for recall from the Miquest response files in a spreadsheet called Summary.xls which is saved on the floppy. This list is then used by the Word document for creating the mail-merged letters for patients and can be used to keep a note of the patients who have been recalled.