PUTTING PREVENTION FIRST Vascular Checks/ NHS Health Checks

VASCULAR DISEASE STROKE TRANSIENT ISCHAEMIC ATTACK CHRONIC KIDNEY DISEASE HEART ATTACK ANGINA DIABETES

WHY A NATIONAL PROGRAMME? The Diabetes, Heart Disease and Stroke Prevention Project: identification of people with diabetes in the general population is best achieved through targeted screening along with other vascular disease The National Screening Committee (NSC) 1 recommended: “the introduction of a vascular risk management programme in which the whole population would be offered a risk assessment that could include, among other risk factors, measurement of blood pressure, cholesterol and glucose” 1 UK NSC Policy Position Chart, November, 2007

WHY A NATIONAL PROGRAMME? Vascular diseases (heart disease, stroke, kidney disease and diabetes) have common risk factors; Vascular diseases (heart disease, stroke, kidney disease and diabetes) have common risk factors; The vascular checks programme offers an opportunity to assess people’s risk for these diseases and offer advice on how to reduce and manage risk; The vascular checks programme offers an opportunity to assess people’s risk for these diseases and offer advice on how to reduce and manage risk; This programme will help ensure greater focus on the prevention of vascular disease and will help people remain well for longer; This programme will help ensure greater focus on the prevention of vascular disease and will help people remain well for longer; The programme has the potential to on average: The programme has the potential to on average: prevent 1,600 heart attacks and strokes prevent 1,600 heart attacks and strokes save up to 650 lives each year save up to 650 lives each year prevent over 4,000 people a year from developing diabetes prevent over 4,000 people a year from developing diabetes detect at least 20,000 cases of diabetes or kidney disease earlier detect at least 20,000 cases of diabetes or kidney disease earlier

WHY A NATIONAL PROGRAMME? Some evidence that HC improves Cardiovascular Disease (CVD) prevention : This policy is highly cost effective, with a conservative estimate of its cost per Quality Adjusted Life Year (QALY) of around £3,000. Although there is some uncertainty in many of the parameters used, sensitivity analysis shows the cost effectiveness of the policy is robust against these uncertainties.

WHY A NATIONAL PROGRAMME? Some evidence that HC improves CVD prevention : This policy is highly cost effective, with a conservative estimate of its cost per Quality Adjusted Life Year (QALY) of around £3,000. Although there is some uncertainty in many of the parameters used, sensitivity analysis shows the cost effectiveness of the policy is robust against these uncertainties. Assumes 1:5 smokers want to quit Assumes 1:7 referrals quit at 1yr Assumes GPs under detect smokers willing to quit. Review Evid. Based Med ARR 9%/NNT 11

Are Health Checks here to stay? “Under the NHS Health Check programme everyone eligible between the ages of will be entitled to undergo assessment of their risk of heart disease, stroke, diabetes and kidney disease.” “Patients will have the legal right to receive a NHS Health Check every 5 years from April 2011.”

What is an ‘NHS Health Check’? Measure risk of cardiovascular disease, diabetes and chronic kidney disease. Results will place in one of 3 risk group (low/med/high) Measure risk of cardiovascular disease, diabetes and chronic kidney disease. Results will place in one of 3 risk group (low/med/high) Set out how to reduce risk/maintain low risk Set out how to reduce risk/maintain low risk Offer tailored package of prevention Offer tailored package of prevention A single, universal, integrated check for all aged

WHAT IS A NHS HEALTH CHECK? Standard questions to assess risk Standard questions to assess risk – age, gender, smoking – family history, ethnicity – medication Measurements Measurements – height, weight – blood pressure Simple blood test Simple blood test – Cholesterol ± glucose ± creatinine depending on filter result

WHY HbA1c? Within best practice guidance; Within best practice guidance; Flexibility in scheduling Health Checks; Flexibility in scheduling Health Checks; No fasting; No fasting; Improved compliance; Improved compliance; Locally recommended; Locally recommended; International consensus : European Association for the Study of Diabetes, International Diabetes Federation, and American Diabetes Association. International consensus : European Association for the Study of Diabetes, International Diabetes Federation, and American Diabetes Association.

INDIVIDUAL ASSESSMENT INDIVIDUAL ASSESSMENT Personal risk assessment Personal risk assessment Individual risk reduction plan with tailored lifestyle advice Individual risk reduction plan with tailored lifestyle advice At low risk levels: At low risk levels: – general advice on staying healthy – repeat check 5 years

AT HIGHER LEVELS OF RISK... Advice and assistance Advice and assistance Specific interventions: Specific interventions: – weight reduction class – exercise referral – smoking cessation clinic

AT HIGHEST LEVELS OF RISK... All of the above plus preventive statin medication ± blood pressure control ± intensive diabetes prevention

Further options… Taking pulse in older groups to identify atrial fibrillation Taking pulse in older groups to identify atrial fibrillation Taking blood pressure measurement in arm and leg to diagnose peripheral arterial disease Taking blood pressure measurement in arm and leg to diagnose peripheral arterial disease COPD filter questions COPD filter questions Mental health filter questions Mental health filter questions Alcohol filter questions Alcohol filter questions Where to stop! Where to stop!

VASCULAR PROGRAMME

MATERIALS

TEMPLATE

ESTIMATES SUGGEST THIS PROGRAMME WILL: And each year will generate at least: And each year will generate at least:  1,154 new referrals for stop smoking advice  4,263 new referrals for weight management  2,917 new prescriptions for anti hypertensive medication  2,132 new prescriptions for cholesterol lowering drugs  396 additional patients newly diagnosed with diabetes  1,109 new patients diagnosed with CKD Offer 26,398 vascular checks a year in Worcestershire at full implementation Offer 26,398 vascular checks a year in Worcestershire at full implementation

CHALLENGES  CALL AND RECALL SYSTEM  QUALITY ASSURANCE – Near Patient Testing/ information transfer if risk assessment undertaken in community  HEALTH INEQUALITIES – Variety of settings  CAPACITY / CHOICE

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