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Hull Healthy Hearts

Outline. The context - CVD in Hull Project drivers The Hull Healthy Hearts Project* Description* Results

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Hull Healthy Hearts

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    1. Hull Healthy Hearts Phil Davis Head of Joint Commissioning & Public Health Development 16th January 2008 Philip.Davis@hullpct.nhs.uk

    2. Outline The context - CVD in Hull Project drivers The Hull Healthy Hearts Project * Description * Results & evaluation Further development Locally Enhanced Service

    3. Hull Population: 260,000 - ranked as the 11th most deprived local authority out of the 354 local authority and districts of England all of 23 wards are within the most deprived 1/3 of all wards in England 8 of 23 wards are in the bottom 2% most deprived wards nationally – 91,000 people (35%) Hull PCT is in the ‘Spearhead’ Group of PCTs and ‘off-track’

    4. CVD Standardised Mortality Rates - Significantly above England & Wales average

    5. Drivers for project CHD mortality rates, NSF and Public Service Agreement targets to reduce inequalities Eastern Hull PCT Local Delivery Plan Locally commissioned review of evidence for primary prevention interventions Timely national publications - Health Development Agency (2004) & Healthcare Commission (2005)

    6. Hull Healthy Hearts Project Eastern Hull PCT Local Delivery Plan 2005-08: Resources allocated for project Project aim: to reduce CHD morbidity and mortality by focusing on measuring and reducing total CHD risk in asymptomatic individuals at moderate to high risk of developing CHD

    7. Hull Healthy Hearts Project How: comprehensive risk assessment in a range of community settings including workplaces estimate individual 10 year CHD risk Personal Heart Health Plan including: signposting to a range of health promoting activities and services eg. smoking cessation services, physical activity direction to GP/Practice Nurse for further tests/initiation of medication where indicated

    8. Hull Healthy Hearts Project Risk assessment - based upon US NHBLI’s Framingham Study Age, Total & HDL Cholesterol, Blood Pressure, Diabetic & Smoking Status Use of Cholestech LDX Near-Patient Testing Device Adjustment for family history & ethnicity Calculate 10 year CHD risk Personalised Heart Health Plan

    11. Individual Personal Heart Health Plan advice & targets for a range of risk factors

    12. Initial results Nurse-led service started July 2005 Provided in range of locations: - Shopping centres - Workplaces - Community events & other locations Targeted at more deprived communities within PCT 1,200+ assessments undertaken – 1,055 CHD risk

    13. Age & gender breakdown

    14. Place of residence

    15. Location of assessment

    16. CVD risk band by age and gender

    17. 95% CIs for CVD 10 year risk (Hull)

    18. Postal questionnaire 800 distributed – 40% response rate Key findings: Service very acceptable and valued Range of locations/times felt to be suitable Hierarchy of value of advice depending upon who supplies it Positive response to life-style advice

    19. Further development Mixed model of provision General Practice / Pharmacies / Community settings & workplaces etc. Embedding of wider public health services within primary care – eg. Active Lifestyles / Smoking Cessation / Health trainers etc. Social marketing

    20. Locally Enhanced Service General Practices and Pharmacies The calculation of 10 yr CVD risk amongst all 40-64 yr olds in Hull not on existing CVD-related registers Signposting in light of risk The maintenance of practice risk registers The on-going intervention in high risk patients identified – intervention would initially focus on the key modifiable risk factors generating the high risk such Cholesterol & Blood Pressure management etc

    21. Target population Males & Females 40-64 – 88,000 people in Hull Estimated that 15% already on CVD related registers Hence 75,000 suitable for service Assume 70% compliance rate through General Practice and a 3 year rolling programme – 17,500 risk assessments pa Remainder through Pharmacies and in Community settings Assumed approx. 20% will be high risk (10 yr risk 20%+) – 18,000

    22. Estimated impact – high risk From work to date estimate 20% will be high risk No. identified pa. - 5,800 These people will have a minimum of 1,170 events over 10 years if no intervention If intervene and reduce risk to 10% then 585 fewer events over 10 years These calculations are work in progress - please do not quote without permission

    23. Est. impact – medium/low risk From work to date estimate 80% CVD risk <20% Medium/Low risk cases identified pa – 23,500 These people will have approx. 2,350 events over 10 years if no intervention (average risk assumed 10%) If reduce risk to 8% through lifestyle change then approx. 470 fewer events over 10 years These calculations are work in progress - please do not quote without permission

    24. LES – some assumptions Risk assessment undertaken by combination of Practice Nurse / Pharmacist / Health Care Assistant Risk assessment takes approximately 15-20 mins Intervention and on-going monitoring of high risk patients will require 2 further GP consultations in year 1 and 1 additional consultation in subsequent years Costings associated with community pharmacists currently being discussed

    25. Practical issues Consultation – 15 - 20 minutes required Skill-mix Practicalities of follow-up Compliance with advice to go to GP for further tests/initiation of medication Clinical judgement – eg. 63 yr old healthy males Hard to reach groups ‘Industrial scale’ public health intervention

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