HMB audit: early results released and clinicians to drive participation

The first national clinical audit of Heavy Menstrual Bleeding (HMB) has produced early findings from its study and is using the opportunity to encourage clinicians to keep driving uptake of the project.

The audit – commissioned by the Healthcare Quality Improvement Partnership as part of NCAPOP and being carried out by the Royal College of Obstetricians and Gynaecologists (RCOG) – is due to publish its first full results in May 2012.

The overall aims of this four-year audit are to describe the care received by women with HMB referred to NHS outpatient clinics in England and Wales and to assess women’s outcomes and experience of care.

At the end of August 2011, some 8924 women had been recruited into the audit. Preliminary results show that about one-third of these women did not have any previous treatment and there are significant variations in the primary care utilisation and treatments patterns in the year prior to their first outpatient gynaecology referral.

This follows the first component of the work, which was completed in August 2010 and collected information from hospitals to evaluate the organisation of hospital gynaecological services, current referral patterns and local protocols with reference to the management of HMB. It was found that of the 221 hospitals included in the organisational survey, only 30% of hospitals had a written protocol on the management of women with HMB and 38% of hospitals held a dedicated HMB clinic.

Over 95% of hospitals offered abdominal or vaginal hysterectomy options and at least one second generation endometrial ablation technique, whilst laparoscopic-assisted hysterectomy was available at 82% of hospitals. Most hospitals also reported that over 50% of their patients had received treatment in primary care, though 17% of hospitals reported that most women seen for HMB did not receive any treatment in primary care.

We are extremely happy with how the audit is progressing,” said Loveleen Bansi-Matharu, HMB Audit Lead at RCOG. “However, we would urge the clinicians involved to continue recruiting all eligible women so as to provide the best quality results possible.”

Link to the HMB audit: http://www.rcog.org.uk/orca/audit

More about the HMB audit:

Heavy menstrual bleeding (HMB) is a common condition affecting 20–30% of women of reproductive age. HMB is estimated to be the fourth most common reason women are referred to gynaecological services and approximately 28,000 women undergo surgical treatment for HMB each year.

The RCOG, in partnership with LSHTM and Ipsos MORI, is conducting the National HMB Audit, which began on 1 February 2010. The overall aims of this 4-year audit are to describe the care received by women with HMB referred to NHS outpatient clinics in England and Wales and to assess women’s outcomes and experience of care.

The audit has two components:

1.       An organisational audit of acute NHS trusts in England and Wales

2.       A prospective audit of patient-reported outcomes for women with HMB

The first component was completed in August 2010 and collected information from hospitals to evaluate the organisation of hospital gynaecological services, current referral patterns and local protocols with reference to the management of HMB. It was found that of the 221 hospitals included in the organisational survey, only 30% of hospitals had a written protocol on the management of women with HMB and 38% of hospitals held a dedicated HMB clinic. Over 95% of hospitals offered abdominal or vaginal hysterectomy options and at least one second generation endometrial ablation technique, whilst laparoscopic-assisted hysterectomy was available at 82% of hospitals. Most hospitals also reported that over 50% of their patients had received treatment in primary care, though 17% of hospitals reported that most women seen for HMB did not receive any treatment in primary care.

The second component of the Audit started in 1 February 2011. Eligible women who have consented to participate in the Audit are asked to complete a questionnaire at their first gynaecology outpatient visit. Questions included are on the severity of the condition, the impact its symptoms have on quality of life and the treatments they have received in primary care.  These women will be followed up after 1 year to collect information on the treatments received since their outpatient visit and on patient reported outcomes.

At the end of August 2011, 8924 women had been recruited into the audit. Preliminary results show that about one-third of these women did not have any previous treatment and there are significant variations in the primary care utilisation and treatments patterns in the year prior to their first outpatient gynaecology referral.