Supporting primary care practitioners to develop knowledge and skills in cardiovascular care Lynda Blue, Morven Dunn October 2014
Practice Development Co-ordinator (PDC) role Overview of role Role rationale Challenges and Opportunities Evaluation Methodology Outcomes Case Scenario
Overview of role Experienced cardiac specialist from seven NHS trusts/boards across the UK seconded to the BHF Two different models - full time and part time The aim of the role is to provide flexible training and information to support HCPs to deliver evidence based CVD practice that improves outcomes BHF provided training to prepare the PDCs for the role The PDCs developed a suite of presentations ranging from prevention to end of life Independent evaluation
Role rationale Complicated and changing health and social care landscape Ageing population, often with complex care needs Shift to increase care delivery in primary care HCPs working in community are required to deliver high quality evidence based care locally Many HCPS lack confidence and knowledge in managing complex CVD conditions HCPs often find it difficult to be released or to access training to develop their CVD knowledge base
Challenges/Opportunities Initially advertising and promoting the new role within their regions took quite a bit of effort and time Once established demand has been high Maintaining their clinical expertise, skills and knowledge is essential Supporting/advising in developing protocols, patient pathways and service redesign
Evaluation Methodology Consultation with the PDCs and BHF field team to understand their perspectives of the role Analysis of data from over 2,000 PDC training session feedback forms Eight case studies of PDC activities, involved consultations with over 40 individuals (telephone and face to face) with training session participants, local stakeholders and PDCs
Evaluation form data - participants 4% 3% 2% Practice Nurse 7% 32% GP Community Nurse 8% Other D/K Health Care Assistant Advanced Nurse Practitioner 9% Community Matron Allied Health Professional Pharmacist N=2,266 13% 20% Admin Staff
Case studies Location/PDC Description Northern Ireland Development of a one-stop cardiac clinic in Lagan Valley South West Scotland Scotland Wales North West Practice Nurse and Community Matron training in Poole Practice nurse and GP training in the Western Isles Training and support for the Fife Managed Clinical Network Community Nurse & HCA training, GP Practice support in Cwm Taf GP training in Knowsley Northern Ireland Contribution to Northern Ireland Cardiovascular Service Framework London Practice Nurse training and CCG engagement in Southwark
Outcomes (1) Overall the role evaluated extremely well and the participant feedback form was hugely positive The most common areas reported as improving knowledge: Medication and equipment Monitoring tests and assessment Patient management and care Diagnosis and referral Understanding of CVD conditions Improved confidence in professional practice and communicating with patients
Outcomes (2) Indirect outcomes Sharing of good practice from one part of the health service/and across the four nations Supporting/advising in developing protocols, patient pathways and service redesign and influencing healthcare at a more strategic level Particular reasons why role worked so well The BHF reputation is well respected and a trusted provider of learning Role designed to address the difficulties reported by HCPs working in primary care, flexible to meet local needs, tailored and relevant to the HCPs
Evaluation form data - feedback The length of the session was appropriate The Content of the event was relevant to my needs Appropriate learning methods were used The education offered by this event was of a high standard Overall this event met my expections Strongly agree Agree Disagree Strongly Disagree All agree 56% 41% 3% <1% 96.9% 64% 34% 2% <1% 97.8% 65% 35% <1% <1% 99.8% 71% 28% <1% <1% 99.7% 65% 34% <1% <1% 99.1%
Conclusion There is much evidence from the evaluation that the role has made a difference and is impacting on the knowledge and skills of HCPs. There is also some evidence that the training and education is leading to improved diagnosis and treatment. A number of unintended outcomes have developed, wider than delivery of education and training, such as influencing both service redesign and healthcare at a strategic level. The demand for the role is high and a there is clearly a defined need, but how the role will further develop will require more in-depth analysis of the final report.
Case Scenario: Western Isles Health Inequalities High incidence of CVD Low Population Geographically remote No local access to specialist physician- specialist care requires referral to tertiary centre
Multidisciplinary Training Isles of Lewis Population 18,500 North & South Uist 3,000 Islay 3,200
Training Sessions 3 x full day training sessions, delivered by 2 PDCs Mixture of teaching- presentations, progressive case studies in group work and quizzes Content determined by each area, from a suite of presentations All topics tailored to the needs of the local services Topics included : ECG, acute coronary syndrome, atrial fibrillation, heart failure, cardiac rehabilitation
Attendance Practice Nurses GPs Paramedics Hospital Nurses Specialist Nurses Physiotherapists
Learning Outcomes Participants Change in practice Immediate: improved drug titration Better use and understanding of ECGs Long Term: more confident in decision making and medicines management BHF Local champion important Teaching needs to be focused on local service provision A lot of preparation needed- but it pays off Single sessions are not enough Good training creates a demand for more learning