LTC reviews

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Clinical Terms
LTC reviews are structured assessments of patients with Long-Term Conditions, conducted by primary care professionals to monitor and optimise their care.

What are LTC reviews and why are they important?

What is ?

Long-Term Condition (LTC) reviews are systematic clinical assessments conducted in primary care settings for patients living with chronic health conditions. These structured reviews typically involve monitoring disease progression, evaluating treatment effectiveness, updating care plans, and addressing any new concerns. They're a cornerstone of proactive primary care, helping to prevent complications, reduce hospital admissions, and improve quality of life for patients managing conditions like diabetes, COPD, hypertension, and heart disease.

LTC reviews Best Practices

What is ?

  • Adopt a person-centred approach that considers the patient's goals and priorities rather than focusing solely on clinical metrics
  • Implement structured templates with condition-specific frameworks while maintaining flexibility to address individual patient needs
  • Coordinate multidisciplinary input from relevant healthcare professionals within the PCN for comprehensive care
  • Incorporate medication reviews to optimise prescribing and reduce polypharmacy where appropriate
  • Use LTC reviews as an opportunity for health promotion and preventative care discussions

Use LTC reviews in a Sentence

What is ?

  1. The practice nurse conducts thorough LTC reviews for patients with diabetes, ensuring their care plans remain appropriate and effective.
  2. PCNs are implementing a shared approach to LTC reviews to standardise care quality across member practices.
  3. The new digital system allows clinicians to prepare for LTC reviews by highlighting key metrics and changes since the previous assessment.
Frequently Asked Questions about
LTC reviews

What does LTC reviews mean?

LTC reviews refer to structured assessments of patients with Long-Term Conditions (chronic health conditions like diabetes, asthma, COPD, etc.) conducted by healthcare professionals in primary care settings. These reviews involve monitoring the condition, assessing treatment effectiveness, updating care plans, and providing education to help patients manage their conditions effectively. They are typically conducted at regular intervals depending on the specific condition and individual patient needs.

How often should LTC reviews be conducted?

The frequency of LTC reviews varies depending on the specific condition, its severity, and individual patient needs. Generally, most long-term conditions require reviews at least annually, with some requiring more frequent monitoring. For example, patients with stable diabetes might have annual reviews, while those with poorly controlled diabetes might need quarterly assessments. Primary Care Networks often develop protocols specifying recommended review frequencies based on national guidelines and local priorities.

Who conducts LTC reviews in Primary Care Networks?

Within Primary Care Networks, LTC reviews are typically conducted by a range of healthcare professionals, depending on the condition and local workforce arrangements. This may include GPs, practice nurses, clinical pharmacists, healthcare assistants, and specialist practitioners. PCNs increasingly employ multidisciplinary approaches, with professionals working at the top of their licence. For example, a nurse might conduct the core review for a diabetic patient, with input from a clinical pharmacist for medication optimisation and a GP for complex cases.

What are the key components of an effective LTC review?

An effective LTC review typically includes several key components: clinical measurements relevant to the specific condition (e.g., blood pressure, HbA1c, peak flow); medication review to ensure optimal treatment; assessment of symptom control and disease progression; screening for complications; mental health and wellbeing assessment; review of self-management capabilities; lifestyle advice; and collaborative care planning. The review should be holistic, considering the impact of all conditions for patients with multimorbidity rather than reviewing each condition in isolation.

How are LTC reviews changing with the development of Primary Care Networks?

With the development of Primary Care Networks, LTC reviews are evolving in several ways. PCNs are implementing more standardised approaches across member practices to reduce variation in care quality. They're increasingly using multidisciplinary teams, with specialists like clinical pharmacists and physiotherapists contributing to reviews. There's greater emphasis on population health management, targeting reviews at those most at risk. Digital platforms are enabling more efficient data sharing and remote monitoring options. Additionally, PCNs are exploring group consultations and community-based reviews to improve access and efficiency.

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