The goal of this project is to provide a descriptive analysis of hypertension metrics available from the CVDPREVENT audit website, as part of a wider evaluation of the Core20PLUS5 approach.
All data used in this analysis is within the public domain.
The analysis uses the R language and has been written into a Quarto .html document.
The recommended approach to re-create the analysis is:
- Install dependencies,
- Ensure necessary folder structure
- Gather the data from the CVDPREVENT application programming interface (API),
- Render the Quarto document.
Run the get_dependencies.R script to
identify the packages used within this analysis. NB, this file requires
at least renv, janitor and dplyr to first be installed on your
system to run.
Run the set_folders.R script to ensure the
necessary folder structure is in place to receive data.
Run the get_cvdprevent_data.R script to download the hypertension indicator data from the CVDPREVENT API.
This script downloads indicator data at England and at Integrated Care Board (ICB) levels and over all time periods for which data is available. ⌛ This process may take a few minutes.
You will likely receive messages in your console during this download process about data not being available. This is to be expected as some indicator data is not available for all time periods.
Open the hyp_eda_wip.qmd quarto file.
If this is your first time, then ensure the parameter
flag_calc_expensive_operations is set to TRUE, as below:
params:
# should expensive calculations be re-calculated?
# default = FALSE. Set to TRUE if running for the first time
flag_calc_expensive_operations: TRUESetting to TRUE will ensure some essential, but computationally heavy,
calculations are performed and the results stored in your data folder.
Once the file is rendered the analysis file can be found in the outputs folder. Your IDE may open this file for you automatically.
The Strategy Unit has been commissioned by the Healthcare Inequalities Improvement Programme (HiQiP) team to evaluate the Core20PLUS5 approach. The evaluation will be longitudinal and mixed methods and will examine changes on both process and outcomes. Scoping activities for the evaluation took place January-June 2024. Work on the evaluation commenced in October 2024 following sign-off for both the evaluation framework and a high-level evaluation delivery plan.
The programme theory for the Core20PLUS5 approach, which is being tested through the evaluation is whether a national approach to tackling healthcare inequalities - which focuses on specific population groups and clinical areas - can provide a structured approach to achieving equitable access, provide excellent experience, and deliver optimal outcomes for all.
The focus of this quantitative element of the evaluation is around hypertension.
This repo supports collaboration of work to provide a descriptive analysis of indicators of hypertension prevalence and care across England from the CVDPREVENT audit website.
| Indicator code | Description |
|---|---|
| CVDP001HYP | Hypertension: Prevalence Prevalence of GP recorded hypertension and no subsequent recorded hypertension resolution, in patients aged 18 and over |
| CVDP002HYP | Hypertension: Treated to appropriate threshold (age < 80) The percentage of patients aged 18 to 79 years with GP recorded hypertension, in whom the last clinic blood pressure (BP) or equivalent home or ambulatory blood pressure reading (measured in the preceding 12 months), is to the age and setting appropriate treatment threshold. |
| CVDP003HYP | Hypertension: Treated to appropriate threshold (age >= 80) The percentage of patients aged 80 years or over, with GP recorded hypertension, in whom the last clinic blood pressure (BP) or equivalent home or ambulatory blood pressure reading (measured in the preceding 12 months), is to the age and setting appropriate treatment threshold. |
| CVDP004HYP | Hypertension: BP monitoring The percentage of patients aged 18 and over with GP recorded hypertension, with a record of a blood pressure reading in the preceding 12 months. |
| CVDP005HYP | Hypertension: High risk – one high BP with no recorded hypertension The percentage of GP registered patients aged 18 and over with a single blood pressure reading of systolic >=140mmHg and diastolic >=90mmHg (indicating increased risk of hypertension), but with no hypertension diagnosis (and no recorded hypertension resolution) in the GP record. The single high blood pressure reading is recorded more than 3 months prior to the audit end date. |
| CVDP006HYP | Hypertension: Potential antihypertensive overtreatment The percentage of patients 18 and over with GP recorded hypertension, prescribed antihypertensive medication in whom the last systolic blood pressure (BP) rea 7347 ding was low (<=100mmHg) who have been prescribed antihypertensive medications after the date of the low systolic BP value. |
| CVDP007HYP | Hypertension: Treated to appropriate threshold (all ages) The percentage of patients aged 18 and over with GP recorded hypertension, in whom the last clinic blood pressure (BP) or equivalent home or ambulatory blood pressure reading (measured in the preceding 12 months), is to the age and setting appropriate treatment threshold. |
| CVDP009HYP | Hypertension: Monitoring with ACR The percentage of patients aged 18 and over, with GP recorded hypertension (excluding patients with chronic kidney disease (CKD) (G3a to G5)), with a record of a urine albumin:creatinine ratio (ACR) or protein:creatinine ratio (PCR) test in the preceding 12 months. |
Hypertension indicators to be analysed
Core20PLUS5 is an approach designed by the Healthcare Inequalities Improvement Programme (HiQiP) team at NHS England to reduce healthcare inequalities. Developed between 2021 and 2022, it is intended to influence practice at a national, regional and system level.
The approach focuses on the most deprived 20% of the population and locally determined ‘PLUS’ groups who experience barriers to accessing healthcare.
It highlights five clinical areas which require accelerated improvement. For adults, these are maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension case finding. For children and young people, these are asthma, diabetes, epilepsy, oral health and mental health.