Cardiovascular Health Westminster: An integrated approach to CVD prevention and treatment Dr Adrian Brown/Anna Cox Consultant in Public Health Medicine NHS Westminster
Why prioritise CVD Biggest killer A quarter of all deaths (28% male and 18% female) 150 deaths annually under age 75 Biggest contributor to health inequalities Hospital admission rates 6.4 times higher in Church St than in Knightsbridge & Belgravia S Asians higher prevalence 80% higher admissions for CHD
Contribution of CVD to Inequalities Contribution to the Life Expectancy Gap between Quintiles One and Five, by Disease Group, Westminster 2002-2007 Circulatory Diseases 36% All Cancer's Respiratory Diseases Digestive 29% External Causes of Injury and Poisoning Infectious & Parasitic Diseases 13% 5% 4% 1% Other 11% 1 Note: Analysis is of Westminster PCT GP registered population resident within the City of Westminster. Source: Primary Care Mortality Database (PCMD), EXETER
Why prioritise CVD Easy to identify at risk people Ethnicity, smoking, BMI, blood pressure, lipids Knowledge of how to reduce risks, and ensure successful clinical outcomes Lifestyle change smoking, diet and physical activity Preventative prescribing anti-platelet, ACE inhibitors, statins Management of acute event thrombolysis, angioplasty Cardiac rehabilitation
Vision of excellence across the continuum of care Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation Underpinning commissioning principles Evidence based - clinically and cost effective Designed to reduce inequalities Designed involving patients and the public Robust monitoring of public health, clinical, patient experience and equality and diversity outcomes Partnership and integration across the continuum of care
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation
Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation Health Promotion Commissioning quality services: Obesity strategy for prevention and healthier lifestyles Smoking cessation Alcohol strategy
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation
Health Promotion Community cardiac team Acute hospital services Rehabilitation Targeted At risk Prevention Vascular Risk Assessment now rolled out in GP Practices (CVD At Risk LES) 40 practices have signed up Furthest ahead in London and part of NHS London Leadership Group test bed site. Informed by CVD engagement strategy Additional VRA in Pharmacies/Community in 2009-10 My Action programme
VRA in Westminster Identifying patients at risk CVD At Risk LES 07-08 all practices have developed At Risk registers Health Intelligence software to identify patients at greater than 20% risk (age, ethnicity and smoking) 08-09 LES to incentivise three areas: Improving risk factor data (ethnicity, smoking, BMI/WC) Patient call for detailed risk assessment (including cholesterol and glucose) Referral to MyAction Currently identified 4,400 new at risk patients but underestimate
Evidence based cardiac prevention programme Based on cluster randomised control trial Euro- Action Lancet June 2008 Intensive programme of risk reduction both preand post event Nurse led with dietetics and physical activity, community location Clear evidence of effectiveness at reducing risk, outcome data awaited Branding and programme centrally controlled at My Action at Imperial
My Action in Westminster Proposed referral process to my action Referral of patients from sources: Cardiac rehabilitation Hypertension registers Diabetes registers (where not currently provided with a preventative service) CHD registers (where have not had recent rehab) New At Risk Registers
My Action in Westminster Commissioning process and investment Investment 700k in 08-09 and 1.3m 09-10 Aiming to offer programme to 4,400 At risk patients in 3 year programme then maintenance programme 7 MyAction Units in 4 locations in the city Due to start in April 2009 Partnership between Imperial College Healthcare NHS Trust and Central West London Community Services Full launch as part of Healthy Hearts and Minds 28 th January 2009
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation
Health Promotion Targeted at risk prevention Acute hospital services Rehabilitation Community cardiac team Re-commissioning services for Heart Failure Complex Hypertension Stable Angina Arrhythmia and AF Criteria to ensure Excellent supervision and governance Linkage to MyAction programme Designed to reduce inequalities One stop and dovetailed to future Polyclinic development with four community locations
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation
Health Promotion Targeted at risk prevention Community cardiac team Rehabilitation Acute hospital services Commissioning quality services Comprehensive list of Clinical Outcome metrics agreed for both CHD and Stroke with ICHT further revision for 2009-10 with better E and D information Clear linkage and integrated care pathways as part of the specification for community cardiac team
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation
Health Promotion Targeted at risk prevention Community cardiac team Acute hospital services Rehabilitation Re-commissioning and review Review of hospital based cardiac rehab (in line with new ICHT) to move majority to community MyAction to provide community service integrated with At Risk programme Close working of MyAction team with Community Cardiac Team
Questions and comments
Providers provide service under My Action specification Roll out in PCTs now started after Bromley Pilot Support from Provider Arm Westminster PCT and Imperial Included in spec with cardiac team If linked to CVD At Risk LES and Community Cardiac Team, huge potential to reduce risk and reduce inequalities Ideal opportunity for investment for PCT
My Action in Westminster Designing the service to reduce inequalities Engagement strategy has specifically been developed Visits to GP practices in areas of social deprivation to elicit views Offer a range of locations for the service and times Engagement of GP clusters Early evaluation to identify success in attracting patients most at risk Linkage with community programmes and social marketing initiatives