Translating Innovation into Practice:The Cardiology Unmet Needs Project
Professor Stuart Pringle and Alison HumeCo-Clinical Leads for the Cardiology Unmet Needs Project
Is there evidence of greater need in deprived communities?
• Yes
What impact does this have on health status and outcome?
• Poorer outcomes• Higher morbidity • Reduced survival.
CABG and angioplasty operations: all ages: rate per 100,000
034
404447
5575
87888989
949899
115144148149
158164
183184
0 50 100 150 200
DD1 3
DD4 0
DD4 6
DD3 0
DD1 4
DD5 2
DD2 4
DD4 7
DD5 3
DD2 2
DD1 2
Inequality (based on 2001 ISD data)
76
140
020406080
100120140
Intervention Control
CABG and Angioplasty rates per 100,000
(Average of deprived intervention group compared to average of affluent control group)
Aim of the project:
1. To improve access to cardiology
2. To deliver services in deprived communities
Modelling and re-modelling of clinical activity
1. Delivery of Specialist Cardiology Clinic (including investigation) in a community venue or the clinical mobile unit
2. Identification of potential ‘patients’ from opportunistic cardiology assessment at local events (e.g. local gala days, bingo, shopping centres, the mosque)
Deprived Communities
Example of venues:The Community Heart Clinic
The Clinical Mobile Unit
Cardiology clinic in Mark Henderson Centre
Local Gala days
Engaging with Ethnic Minority Groups
Radio Ramadhan 107.5
Lochee Baptist Church
Results
• A total of 1781 people have engaged with clinical project activity
• 1632 have self presented for an opportunistic cardiology assessment (Specialist nurse led)
• 161 have had a specialist clinical consultation (Cardiologist led)
• 91 people have had a heart failure clinical review
• 17 people have had a heart failure telephone clinical review
10% of the above are of South Asian ethnicity
Success of engagement with people living in the deprived communities
• Areas with the highest deprivation in Tayside have been targeted for clinical activity
• By delivering services in the deprived areas the majority of people who have engaged are from the poorest areas of Tayside
• By taking clinical services to places of worship, engagement with the ethnic groups has been particularly successful
Breakdown by deprivation category
05
10152025303540
%
1 2 3 4 5 6 7Deprivation category
Area of residence ofpeople who haveengaged with projectclinical activity
Gender
0
10
20
30
40
50
60
70
%
assessment clinicalreview
heartfailurereview
telephonereview
malefemale
The Specialist Cardiology Clinic
161 people have had a clinical consultation
• 73 of these had a diagnosis of CHD• 82 had no known CHD but described significant
symptoms • 6 people believed they had CHD but this diagnosis
was not confirmed following specialist consultation
Investigations as a result of specialist cardiology consultation145
115
248 5
0
20
40
60
80
100
120
140
number of patients
ECG ECHO ETT ANGIO TETSCAN
Some people included in these figures are awaiting Some people included in these figures are awaiting further tests and investigationfurther tests and investigation
Medication management following specialist cardiology consultation
Of the 161 people who were seen by the cardiologist, 77 (48%) had a recommendation for medication management to optimise their treatment
What have we learned so far?
• Feasible• Acceptable – patient and HCP• Opportunistic assessments are popular• Clinical Diagnosis• Interventions – may be quite low tech e.g. up-titrating or
optimising medication• Engagement / re-engagement• Valuable• Cost-effective?• Educational