Health Promotion in Primary Care

1. Health Promotion in Primary Care Dr Lola Savage 15th February 2012

2. AIM • To increase awareness of health promotion in General practice • Case presentation • NHS health Check • Questions-Single best Answer

3. GP Curriculum • Healthy people: promoting health and preventing disease

4. Definition • WHO: Health promotion is a process of enabling people to increase control over and to improve their health

5. Prevention • Health Professionals-we aim to prevent diseases in our patients • Prevention can be classified into the following: • Primary prevention • Secondary prevention • Tertiary prevention • Which of the above categories do we spend most of our time doing?

6. Primary prevention • What health promotion activities do we currently advocate in primary care?

7. Primary Prevention • New Patients • Well woman and well man clinics • Immunisations • Travel advice • Screening programmes- cervical/mammogram/STI

8. New patients health check • Urinalysis • BMI • Blood pressure • Smoking status • Exercise • Alcohol screen-Audit C • Family hx • Ethnicity • Health ed- diet/ exercise-recorded • Well woman/men check: • Smear status

9. How do we as GP registrars incorporate primary prevention into our practice?

10. How can we incorporate health promotion into our consultations • Medication review-review summary records- alcohol intake/BMI/cholesterol/renal function • Pill check-promote LARC • Adhere to prompts for QOF- e.g smoking/ blood pressure reading • Pregnant patients-folic acid/blood pressure/alcohol/smoking/diet/vit D/refer to community midwife • ? Promote NHS health checks

11. Case Presentation • 53 man who presented with a 12 week history of Left foot pain following a car going over his foot in a motorcycle event. X-ray left foot-NAD • PMH- Essential Hypertension • DHx-Amlodipine 5mg od (last issued may 2010) • SHx- Runs his own company. Doesn’t smoke • What should I do next?

12. Case Presentation • Took brief hx of the pain/ex his left foot and decided to refer him for physiotherapy • Establish a rapport with him and explored his ideas about his medical hx and non compliance with medications • Clinic blood pressure readings: 174/85, 162/93

13. Case Presentation • Arrange for him to do home readings for a week and to review again • Average home readings-156/90 • Reviewed risk- bloods- cholesterol/renal function/glucose • Q-risk- 9.5% • Nice guidelines- ACEI- ramipril • Reviewed in 1/12- bp 130/86 • Follow up- pt applied for health insurance- declined-previous hx of non-compliance to meds

14. NHS health check • Background • Heart disease/ Stroke /Diabetes and kidney disease are the biggest cause of death in the UK • 4 million of people in the UK affected • 170,000 people die each year in England from these conditions • Health inequalities in deprived areas and in certain ethnic groups • 2008-DoH published ‘Putting Prevention First’ –sets out a systematic and integrated approach to assess individuals between 40-74 • This National Screening Programme is known as Health Checks- due to be rolled out by PCTs in 2012/2013

15. NHS health check • Invites patients ages 40-74 who are not known to have DM/CVD/TIA/ MI/HT once every 5 years • Fixed factors-Age/ Gender/Ethnicity

16. NHS health checks • Aims • To identify patients at risk of developing MI/CVA/TIA/Diabetes/HT • To sustain increase in life expectancy • To reduce premature death associated with obesity/sedentary life • Reduce health inequalities • Reduce the cost of long term ill health on the NHS

17. What does it look like?

19. Questions-Single best Answer

20. 1 Which of the following statements does not apply to the Cardiovascular Disease Screening Programme? a) Cardiovascular disease screening will identify risk factors that will contribute to vascular disease b) Early intervention can reduce the onset of vascular disease c) Cardiovascular Disease screening will support patients who have had a heart attack. d) Cardiovascular Disease screening can prevent and in some circumstances reverse the onset of vascular disease 2 For what age group is the National Cardiovascular Disease screening programme recommended? a) 20yrs- 40yrs b) 30yrs- 64yrs c) 35yrs- 65yrs d) 40yrs- 74yrs 3 Which of the following blood pressure measurements would you refer your client to their GP? a) 130/75 b) 130/85 c) 140/85 d) Above 140/90

21. 4 Which of the following risk factors can be modified or potentially reversed in the Cardiovascular Disease Screening process? a) Age b) High Blood pressure c) Ethnicity d) Family History Cardiovascular disease 5 Which of the following conditions will not affect a patient’s Cardiovascular Disease risk calculation? a) Smoking b) Elevated BP c) Diabetes d) Alcohol • Why would a 45 year old male who smokes, has a blood pressure of 160/90, Total Cholesterol/ HDL ratio of 6.0 and a BMI of 27.7 have a low CVD QRISK Risk Score of 8%? a) They drink above the recommended 21 units of alcohol per week b) They have Asthma c) Because he is 45yrs old d) Because he has Diabetes

22. 7 Lifestyle advice/or referral as part of the NHS Health Check is important because…. a) Fresh air is good for everyone b) It offers patients the opportunity to make lifestyle changes that will improve their health c) It looks good for the practice d) The government thinks it’s a good idea. 8 When should a patient be sent for a fasting blood glucose test for assessment of Diabetes through NHS Health Checks? a) BMI is in the obese range >30 b) Blood pressure is at or above 140/90, or where the SBP or DBP exceeds 140 or 90 respectively. c) The patient has a BMI >27.5 and is either Indian, Pakistani, Bangladeshi, Other Asian or Chinese d) All the above

23. Summary • Increase awareness of health promotion in primary practice • Case presentation • NHS health checks

24. Anyquestions?

25. Thank you

26. References • www.doh.gov.uk. Putting prevention first. Vascular checks: risk assessment and management • Oxford handbook of GP