Transcript Slide 1

Cardiac MCN
April 2007
Tackling Health Inequalities:
Keep Well Programme
Tackling Health Inequalities
• Background in Grampian
– Evidencing health inequalities locally
• MCN Annual Report
• Keep Well Programme
BACKGROUND
NHSG Framework for reducing
health inequalities (2004-2007)
• ‘A pivotal task signalled in our Local
Health Plan is the need to action a
system-wide approach to tackle health
inequalities to increase penetration on
addressing health inequalities
throughout our business and in
conjunction with our partners.’
Aberdeen City: Area Level Blue Lights
POPULATION INDICATORS
Population aged 0-15
Population aged 16-64
Population Description
Population aged 65+
Migration - population inflow
in previous year
Migration - population
outflow in previous year
Minority ethnic groups
Births
Average age of first-time
mothers
Travel to work/study by
foot/bike/public transport
Prescriptions (DDDs): antidepressant related
Prescriptions (DDDs):
cardiovascular-related
ABERDEEN
CENTRAL
ABERDEEN
NORTH
ABERDEEN
SOUTH
Are there Health Inequalities in Grampian?
EXAMPLE: Aberdeen Central: Area Level
Communities/ Indicators
Population Demographics
Life expectancy - males
Life expectancy - females
Proportion of 15 year-old
boys surviving to 65
Proportion of 15 year-old
girls surviving to 65
Deaths
Teenage pregnancies (3 year
total)
Low birthweight babies (3
year total)
ABERDEEN
AB10 1 AB11 5 AB11 6 AB15 4 AB15 5 AB24 1 AB24 2 AB24 3 AB24 4 AB24 5 AB25 1 AB25 2 AB25 3
CENTRAL
Ischaemic Heart Disease Mortality U75s in Grampian (2001-05)
by National Quintiles
Figure 3b
Ischaemic Heart Disease Mortality for Under 75s in Grampian (2001-05)
by National Quintiles
200
180
160
140
SMR
120
100
80
60
40
20
0
SMR
1
2
3
4
5
66.7
90.7
113
150.9
190.2
Quintiles
Ischaemic Heart Disease Mortality U75s 1999-2004
by Local Authority & Scottish Index of Multiple
Deprivation Quintile
Figure 4b
Ischaemic Heart Disease Mortality for Under 75s in Grampian 2000-04
by Council Area & National SIMD Quintile
250
200
SIMD
150
100
50
0
1
2
3
4
5
Aberdeen City
58.8
91.2
110.6
143.8
195.5
Aberdeenshire
79
90.5
111.5
166.7
178.2
75.9
93.3
107.3
113.9
0
Moray
National Quintile
Aberdeen City
Aberdeenshire
Moray
Scottish Index of Multiple Deprivation
(SIMD) 2006
Aberdeen City
Domain
All Domains
SIMD 2006 –
Numbers of
Datazones in worst
15%
27
Current Income
22
Employment
27
Health
43
Education, skills & training
28
Housing
41
Access to services
10
Crime
59
SIMD 2006 - Local Authority Data
Data Zones in Most Deprived 15% (per 10,000 popn)
6.0
5.0
4.0
3.0
2.0
1.0
0.0
ES
Mo
Or
Sh
EL
AS
SB
ED
ER
Mi
P &K
An
D&G
Hi
St
WL
A &B
SA
Fa
Fi
AB
Ed
SL
Re
EA
NA
NL
Cl
WD
Du
In
Gl
SIMD 2006
Numbers affected
SIMD 2006
Aberdeen
 No. of Data Zones
 Population
 % of Total Population
Aberdeenshire
 No. of Data Zones
 Population
 % of Total Population
SIMD 2006
27
18,027
8.9%
6
4,353
1.9%
MCN Annual Report (1)
Plans for coming year include:
• ‘…contribute to the targeting of NHS resources
to those areas of greatest deprivation.’
• ‘…contribute to prevention of coronary heart
disease in the community through working with
GP practices. We are involved with several
primary care initiatives to improve prevention.’
• ‘….develop improved links with the Community
Health Partnerships.’
• ‘…make more use of the information we already
collect in the NHS and feed it back to staff….’
MCN Annual Report (2)
Related Initiatives
• Scottish Primary Care Collaborative – CHD and
Access
– Measurable targets….
• Absolute reduction in CHD mortality per year
– Improvement measures…
• % of CHD patients on statins
• % of CHD patients with last recorded BP below
140/80
• Number of recorded CHD deaths
• Patient/Public involvement
• Grampian Cardiac Symposium for GPs and Allied
Staff
KEEP WELL PROGRAMME
in NHSG
What?
Who?
How?
With what effect?
Where?
With what?
Local arrangements?
Starting when?
WHAT?
National programme
Wave 2 pilot in Aberdeen City to:
• Increase the rate of health improvement in
deprived communities;
• Tackle cardiovascular disease and its main
risk factors;
• Tackle intermediate clinical risk factors;
• Tackle lifestyle risk factors;
 Tackle life circumstances (eg levels of
income, employment, literacy)
• Monitor nationally and locally.
WHO?
• Target 45-64 year olds at risk of
preventable serious ill-health.
HOW?
• Enhancing primary care services to deliver anticipatory
care;
• Identifying and targeting those at risk of preventable
serious ill-health;
• Offering appropriate, core, evidence-based interventions
and services;
• Delivering through a mix of providers;
• Focusing on cardiovascular disease and its main risk
factors;
• Incorporating appropriate means of engagement with
different client groups;
• Setting clear targets for reach, outcomes and
outputs;
• Providing individual monitoring and follow up;
• Building on, not replicating, nGMS contract and 2006
Directed Enhanced Services (DES).
WITH WHAT EFFECT?
Short term
• Improving REACH:
number on risk register;
number contacted;
number attended;
number fully risk assessed.
• Improving UPTAKE:
improved access;
% receiving clinical interventions;
% referred.
• Improving COMPLIANCE : % continuing treatment at
follow up.
• Improving SERVICE USEAGE: increased prescribing;
increased use of GP practices & local services.
WITH WHAT EFFECT?
Medium term
• Reducing CVD risk; Quit rate; smoking;
BMI; cholesterol; blood pressure; diabetes
management.
• Reducing additional risk factors:
Physical activity levels; healthier diet
(fruit, veg, fat, salt); alcohol consumption.
• Increasing patient satisfaction: Healthrelated QoL; quality of contact with GP.
WITH WHAT EFFECT?
Long term
(5-10 years post roll out)
• Reducing CVD morbidity and premature
mortality in deprived areas;
• Reducing health inequalities.
WHERE?
• In Aberdeen City for the most deprived
15% of population.
• Post pilot, general principles to apply
to those ‘at risk through deprivation’ in
Grampian.
Flow diagram for identifying Keep Well intervention group
Population aged 45-64 years registered with pilot GP practice
On CHD/CVD register?
Yes
No
Taking part in secondary
prevention programme?
CHD/CVD or diabetes
present?
Yes
No
Yes
No
Put on CHD/CVD
register
Is participation optimal?
Calculate CVD risk
Yes
No
See Section X
≥ 20%
Tailored ‘high risk’ CVD prevention package
Keep Well intervention group
Maintain/monitor/follow up
< 20 %
Tailored
prevention
package as
applicable
WITH WHAT?
• Additional resource of 0.5 million per year for
each of 2007-08 and 2008-09.
STARTING WHEN?
• Proposal submission 6 June 2007
• November 2007
LOCAL ARRANGEMENTS?
• Keep Well Group established to engage
relevant parties, in particular GP Practices, in
setting up Programme.
Thank you