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Abdominal Aortic Aneurysm – How a new screening programme is set up

Abdominal Aortic Aneurysm – How a new screening programme is set up. 9.10.12. Presenter: Llywela Wilson Programme Lead AAA screening project. Screening.

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Abdominal Aortic Aneurysm – How a new screening programme is set up

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  1. Abdominal Aortic Aneurysm – How a new screening programme is set up 9.10.12 Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol Presenter: Llywela Wilson Programme Lead AAA screening project

  2. Screening ‘…is a process of identifying apparently healthy people who may be at increased risk of a disease or condition. They can then be offered information, further tests and appropriate treatment to reduce their risk and/or any complications arising from the disease or condition.’ (UK NSC Available at: http://www.screening.nhs.uk/screening Accessed on 5th September 2012) Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  3. Background • 2007: NSC approved screening for AAA in men aged 65 using abdominal ultrasound. • Men should be provided with clear information about the risks of AAA surgery • Networks of vascular services should be created for repair of screen-detected aneurysms Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  4. Background • 2010 Public Health Wales asked to plan the introduction of AAA screening in Wales and project was established • August 2012 Minister for Health and Social Services approved funding for the Welsh programme Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  5. Implementation • June 2012 UK countries Rolling out screening geographically- full implementation 2013 • Plan to implement Spring 2013 • Implementation June 2012 – with full rollout end of 2013 Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  6. Abdominal Aortic Aneurysm (AAA) • Swelling of aorta • 6x more common in men than women • More common with increasing age • Usually asymptomatic until rupture Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  7. Ruptured AAA • Responsible for 2.5% deaths in men aged 65+ • 426 deaths in Wales, 2010 • 246 deaths in men • 180 deaths in women • 228 deaths in men aged 65+ • Overall mortality ruptured AAA: 80% Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  8. AAA screening project Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  9. Project Initiation Document (PID) • PID defines the project • Forms the basis for the project management • Assessment of the project’s overall success • Commitment to the project by Project Board Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  10. AAA Project structure Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  11. Aim The aim of the Wales Abdominal Aortic Aneurysm (AAA) Screening Programme is to halve AAA related mortality by 2025 in the eligible population through a systematic screening programme for 65 year old men resident in Wales. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  12. Screening for AAA • Abdominal ultrasound of 65 year old men resident in Wales • No aneurysm: discharge • Small aneurysm: repeat scan annually • Medium aneurysm: repeat scan every three months • Large aneurysm: refer to vascular network MDT for elective repair Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  13. Wales AAA Screening Programme Service Model Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  14. WAAASP Reporting Structure Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  15. Baseline Review • HB implementation teams • Questionnaire: • current baseline of vascular services • local screening programmes • incidental surveillance • Health Board visits Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  16. Key elements of the AAA Screening Programme Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  17. Identification • Eligible population: 65 year old men living in Wales • Development of an information system – ASIMS • Partnership working between Screening Division & NWIS • Eligible population identified through the Welsh Demographic system (WDS) • Developing IM & T procedures to receive information from WDS • ASIMS required for call/recall, failsafe, evaluation • Experience from Bowel Screening Wales • Equality Impact Assessment • Vulnerable and hard to reach adults • Prisoners, homeless, long term care, transgender group etc Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  18. Invite • Close collaboration between administration and IM & T sub-groups • Develop procedures to ensure the invitation is: • sent to the right man • at the right time • to the right address • Eligible men will receive an invitation letter and a general information leaflet three weeks before appt. Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  19. Inform • Informed consent • Stakeholder analysis (Public/ Professional) • Stakeholder engagement Public: • Screening Division Public Involvement database • Voluntary Sector agencies • Community Health Councils • Royal Welsh Show • Virtual reading panel (VRP) • Lesbian, Bisexual, Gay & Transgender (LBGT) • Understanding and perceptions of AAA • Barriers to screening • Men’s attitudes to screening • Accessibility to services • Public information requirements • Health promotion and marketing of the new programme Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  20. Inform • Stakeholder engagement Professionals • Best way to communicate a new programme? • Bi-monthly bulletin • Development of website • Branding Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  21. Test • Community setting • Identify sites for screening and surveillance • Negotiations with Health Boards & GP Practices • Modelling of frequency and scheduling of clinics • AAA screeners • Train and quality assure screeners • Education provider • Procure and quality assure ultrasound equipment Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  22. Surveillance • Dependent on size of AAA • Annual scan • Quarterly scan • Surveillance support service • offered a phone appointment with the AAA surveillance nurse to discuss the result in more details and the implications of an AAA on their health • Men will be encouraged to make appointment with GP Practice for lifestyle and health advice, BP monitoring and best medical therapy (if required) • Presentations at GP education sessions Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  23. Identify Large AAA • Development of referral pathways • Collaboration between HB professionals • Men will be referred to a regional MDT - elective vascular network • Men will be offered a phone appointment by the Programme’s Regional Coordinators to: • discuss the result in more detail • discuss care pathway Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  24. Treatment/ interventions • Baseline review of vascular services • Facilitate the development of vascular networks to national standards • Quality assure treatment services • Minimise mortality in the eligible population Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  25. Monitor outcomes • Evaluate the programme: • to demonstrate balance of good and harm • provide data to UK audits • Develop performance management structure • Level 1 indicators for Welsh Government & Public Health Wales Exec Board • Level 2 indicators for AWMG • Level 3 indicators for Local MG Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  26. Programme Documentation • Quality manuals • (1) Quality control • (2) Core reference • (3) Administration SOPs • (4) Screening Episode SOPs • (5) Surveillance SOPs • (6) Referral to vascular services Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  27. Implementation • Implementation plan • Media campaign • Transitional plan from AAA project to Wales AAA Screening Programme • Project evaluation WAAASP Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

  28. Thank you… • Any questions? Screening for abdominal aortic aneurysm Sgrinio am ymlediadau aortig abdomenol

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