cardiac mcn april 2007 tackling health inequalities: keep well programme
Post on 14-Dec-2015
219 Views
Preview:
TRANSCRIPT
• Background in Grampian– Evidencing health inequalities locally
• MCN Annual Report
• Keep Well Programme
Tackling Health Inequalities
BACKGROUNDNHSG 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 CENTRAL
ABERDEEN NORTH
ABERDEEN SOUTH
Population aged 0-15
Population aged 16-64
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): anti-depressant related
Prescriptions (DDDs): cardiovascular-related
POPULATION INDICATORS
Po
pu
lati
on
De
sc
rip
tio
n
Aberdeen City: Area Level Blue Lights
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)
AB25 3AB24 4 AB24 5 AB25 1 AB25 2AB15 5 AB24 1 AB24 2 AB24 3AB10 1 AB11 5 AB11 6 AB15 4
Popu
latio
n De
mog
raph
ics
ABERDEEN CENTRAL
Communities/ Indicators
Are there Health Inequalities in Grampian?EXAMPLE: Aberdeen Central: Area Level
Figure 3bIschaem ic Heart Disease M ortality for Under 75s in G ram pian (2001-05)
by National Quintiles
0
20
40
60
80
100
120
140
160
180
200
Q uintiles
SMR
SM R 66.7 90.7 113 150.9 190.2
1 2 3 4 5
Ischaemic Heart Disease Mortality U75s in Grampian (2001-05) by National Quintiles
Ischaemic Heart Disease Mortality U75s 1999-2004 by Local Authority & Scottish Index of Multiple
Deprivation QuintileFigure 4b
Ischaem ic Heart Disease M ortality for Under 75s in Gram pian 2000-04by Council Area & National SIM D Quintile
0
50
100
150
200
250
National Quintile
SIMD
Aberdeen City Aberdeenshire M oray
Aberdeen City 58.8 91.2 110.6 143.8 195.5
Aberdeenshire 79 90.5 111.5 166.7 178.2
M oray 75.9 93.3 107.3 113.9 0
1 2 3 4 5
Scottish Index of Multiple Deprivation (SIMD) 2006 Aberdeen City
Domain
SIMD 2006 – Numbers of
Datazones in worst 15%
All Domains 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)
0.0
1.0
2.0
3.0
4.0
5.0
6.0
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 2006Numbers affected
SIMD 2006 Aberdeen SIMD 2006
No. of Data Zones Population % of Total Population
27 18,027 8.9%
Aberdeenshire
No. of Data Zones Population % of Total Population
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.
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: Health-related 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
Taking part in secondary prevention programme?
Tailored ‘high risk’ CVD prevention package
Yes No
On CHD/CVD register?
CHD/CVD or diabetespresent?
No
< 20 %
Put on CHD/CVDregister
Yes No Yes
Is participation optimal?
Calculate CVD risk
See Section X Yes No
≥ 20%
Tailored prevention package as applicable
Keep Well intervention group
Maintain/monitor/follow up
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.
top related