1 / 60

Denise Lewis Cardiac Rehabilitation Service Co-ordinator

Denise Lewis Cardiac Rehabilitation Service Co-ordinator. WALES. Ceredigion and Mid Wales NHS Trust. Population. Ceredigion – 75,000 Catchment population –121,000 Plus holiday-makers and students. Background Summary. 1996 £25,000 pump priming BHF 2 year grant Employed IWTE C.R. Nurse

lorne
Download Presentation

Denise Lewis Cardiac Rehabilitation Service Co-ordinator

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Denise LewisCardiac Rehabilitation Service Co-ordinator

  2. WALES

  3. Ceredigion and Mid Wales NHS Trust

  4. Population • Ceredigion – 75,000 • Catchment population –121,000 • Plus holiday-makers and students

  5. Background Summary • 1996 • £25,000 pump priming BHF 2 year grant • Employed IWTE C.R. Nurse • In Kind services by dietician, pharmacist, physiotherapist, cardiac nurse. • Full funding for C.R. Nurse when grant money ended

  6. Back ground to the Present Service • In Nov 2003 a Big Lottery Fund award of £289,572 allowed the development, implementation and evaluation of the Ceredigion Communities Cardiac Rehabilitation Scheme. • Previously the supervised exercise element was only available at Bronglais hospital, once weekly, and only for patients recovering for a Myocardial Infarction (M.I) living within the Aberystwyth area.

  7. How Did We Do It?Partnership Bidding Ceredigion health alliance

  8. Geophysical Problems Geographically remote – sparse, rural, isolated population • Deprived areas • Poor public transport links • Growing Elderly population ‘ rural deprivation can be difficult to recognise as it often exists in isolated pockets and, because most statistical measures fail to take account of spatial factors which are a feature of rural deprivation, it is difficult to illustrate statistically’. Dyfed Powys Public Health Annual Report 2002

  9. Previous service INADEQUATE • Poor access to services • 1 whole time equivalent CR Nurse post hospital based • 1 exercise session per week, in physiotherapy dept at BGH hospital ,for 8 weeks.

  10. The Cardiac Rehabilitation Annual Report of 2000 stated that • Of those patients admitted to hospital with a primary diagnosis of M.I only 40% of those eligible attended hospital based Cardiac Rehabilitation.. • Patient reasons for non attendance • distance to hospital (for most this would mean a round trip • 60 miles) • local transport is inconvenient and inaccessible • inability to drive due to cardiac condition • 4 hrs away from employment

  11. Patient service questionnaire for Cardiac Rehabilitation 2000 Reported that: • Readmission rates following M.I. had fallen from 23% 8.3% • Smoking cessation had risen from 68.1% to 91% • 92.3% attributed there recovery to the Cardiac Rehabilitation Specialist Nurse • Complianceby patients has significantly risen in • cholesterol management, • medication compliance • healthy eating • exercise • and weight loss

  12. Aims - in Real Language • To show people how much fun exercise can be • To have a good laugh • To keep them out of hospital • To find out if what we do makes a difference • To find out if we are doing a good job • To find out what we need to improve on

  13. Aims - in Real Language • To help people through the rough times when they have had bad news about their condition and get them back on track • To explain all the double Dutch jargon provided by medics/cardiologists , ETC

  14. Aims - in Real Language • To be that shoulder to cry on • To teach them all about different ways to keep healthy • To try and stop them from having another cardiac event

  15. Aims in Real Language • Help them to cope with having a heart problem • To help them make new friends • To always have any open door should they need it • To teach them how to get the most from life and live longer

  16. In “Sales Talk” What Was Actually Said • To promote the benefits of a healthy life style of participants and their families • To Promote social integration and reduce social isolation through the provision of community based cardiac rehabilitation • To promote a non threatening, non institutional approach to health promotion

  17. Cont.. • To provide a research based cardiac rehabilitation service that is accessible for those residents of Ceredigion with established CHD • To provide and promote a safe and effective, approved programme………. • To establish a multi disciplinary approach to health care

  18. What Did We Need? • Evidence of Need - audit, annual reporting ,the bigger picture, link in with other organisations • Enthusiasm - be positive • Guts - don’t be afraid to ask for help • Determination- ask yourself how much you really want it. If you don’t truly believe in what you are saying no one else will

  19. What Don’t You Need? • A negative attitude - nobody likes a whiner • A false perception that lots of people will want to help you • A false perception of how time consuming it is – a good quality report requires time investment

  20. Monitoring/Evaluation • In partnership with the Sports and Exercise Science Department, University of Wales, Aberystwyth. PHD Student • Data collection mechanisms include: • Participant throughput numbers • Physiological/psychological pre- and post-testing • Follow up evaluation questionnaires/focus group meetings • Reduction of further cardiac events – retrospective study of readmissions • Audit data collected from risk factor management tool • Feedback sessions for staff,participants involved

  21. The results below indicate the trend of the direction of change pre classes to post classes, post classes to 6 month follow up and the overall trend of the score

  22. 6 month Maintenance Usage12 Months • Aberystwyth 840 • Aberaeron 88 • Cardigan 376 • Lampeter 639 Total Usage 1374 *Only gym use. *Does not include swimming or circuits

  23. Evaluation of Outcomes • 503 patients were referred in 24 months indicating the level of demand.

  24. Evaluation of Outcomes • 74% of referrals started classes indicating attractiveness. 69% of patients completed treatment (national average completion rates are 50%). Early exit was mainly due to ill-health. This ill-health was associated with the patients’ condition, not as a result of the scheme where there were no hospitalisations, resuscitations or deaths.

  25. Evaluation of Outcomes • The main source of referral was the hospitals. A variable rate of referral from different GP and health centres reflected different extent of engagement.

  26. Evaluation of Outcomes • The scheme utilised local authority leisure centres throughout the county demonstrating successful partnership work and the local community-base to the programme. • Participant evaluation was very strong with around 90%+ reporting high satisfaction with the organisation, the staff, the exercise programme, and their own personal improvement in fitness, health and confidence

  27. Evaluation of Outcomes • The structure of the Scheme and the approach of the exercise leaders helped participants improve their feelings of confidence and independence. Social aspects of the approach were also important. These factors were considered important in achieving a high adherence and continuation rate.

  28. Evaluation of Outcomes • The comprehensive programme resulted in statistically significant improvement in health-related quality of life, self-worth, habitual physical activity, and exercise tolerance along with a significant reduction in anxiety, skin-folds and resting heart rate.

  29. Evaluation of Outcomes • Six-month follow-up after patients left the scheme showed a sustained impact. Of the follow-up sample of 121, 46% (80% of responders) were still exercising and demonstrated a sustained improvement in habitual physical activity, exercise tolerance and physical health-related quality of life.

  30. How Do We Fit ?

  31. National and Local Plans / Policy ? • Improving Health in Wales: A Plan for the NHS and its Partners. (National Assembly for Wales; February 2001). • Improving Health in Wales: the Future of Primary Care: A Consultation Document (National Assembly for Wales; 2001) • National Service Frameworks for CHD (2001)

  32. Designed for Life: Creating World Class Health and Social Care for Wales in the 21st Century (National Assembly for Wales; May 2005)

  33. Ceredigion Health Social Care and Well Being Strategy 2005-8 Major Risks to health and social well being include; • Ischaemic heart Disease • Unhealthy diet • Lack of exercise • Smoking • Obesity • Substance and alcohol abuse • Poor geographical access to services • depression

  34. Provide cardiac rehab specialist services accessible for all residents of Ceredigion with established CHD • Providing cardiac rehabilitation scheme and access to long term facilities which are close to the patients home • Working in partnership with other organisations Ceredigion county Council, Aberystwyth University Sports Science Dept, Primary Care

  35. Clear pathways of Cardiac Rehabilitation Care • Including; • early assessment • self management plans • multi disciplinary approach to Cardiac Health and Well being • Pro active participants - taking responsibility • Chronic disease management of cardiac patients • Reduction in crisis management of cardiac patients

  36. An Evolving Community service?

  37. Participant Driven • Supervised WOODLAND walks • 16 Supervised exercise sessions per week • Flexible to the needs of those with Chronic Disease

  38. What have WE Gained • Knowledge and experience of • project management • Working in partnership with other organisations • Removing barriers to success • Greater health gains • Greater understanding of the research process A service which has been properly researched using validated physical /psychological tools • The opportunity to: • show our vision was achievable and is successful • improve our standards, develop protocols, • Professionally develop • Show capability to lead a project

  39. IMPLICATIONSFROM APRIL 07 ?

  40. Complete withdrawal of service from ALL four leisure centres across the county, Lampeter, Aberystwyth, Cardigan, Aberaeron. No community based service. • 1 WTE job share cardiac rehabilitation nurse- hospital based • 1 exercise session per week- hospital based in physiotherapy dept BGH hospital. • Inequality of service provision

  41. Ceredigion producing less confident, more dependant cardiac patients, with • increased anxiety, • decreased fitness • who are more likely to generate avoidable admissions to secondary care and avoidable G.P visits.

  42. Potentially, cardiac rehabilitation has prevented this for 377 patients. • The cost saving to secondary care, based on average days in hospital, would have been £484,633.50 for 2 years.

  43. Costings

  44. What Did the Commissioners SAY?

  45. Videoconferencing • Overcome some of the problems of rurality • Improve time-management • Currently for Machynlleth patients • Planned roll out to Tywyn patients

  46. Health of the Community • All primary schools in Ceredigion using our bi-lingual workbook - Keep Your Heart Healthy (ages 7-11)

  47. School Sports Tops • Logo + “Keep Your Heart Healthy – Be Active/Cadwch Eich Calon Yn Iach – Byddwch Fywiog” • Visual message to raise awareness of the importance of activity in the prevention of CHD • Money raised by patients local business and organisations

More Related