Keep Well

Evidence from the Keep Well programme in NHS Grampian – 2008 to 2014

Jackie FlemingKeep Well Information Analyst

What is Keep Well?•Inequalities-targeted national programme•In NHSG since 2008…..in Aberdeen City and Moray (Well North)•Health checks covering•Clinical AND health behaviour AND life circumstances•Anticipatory care•CVD risk screening (ASSIGN)•Referral and signposting

Eligibility for Keep Well•Core group•age 40-64, and living in deprived areas

•Vulnerable groups•South Asian (35-64)•Black Afro-Caribbean (35-64)•Gypsy Travellers (18-64)•Substance misusers (18-64)•Homeless (18-64)•Criminal Justice (18-64)

Eligibility for Keep Well•Core group•age 40-64, and living in deprived areas•identified using the Scottish Index of Multiple Deprivation (SIMD)

•Preliminary work gave GP practices a profile of their Keep Well patients:•More than two thirds had had a surgery consultation within the previous 12-18 months

Where is Keep Well delivered?In 2008/09, via 5 GP practicesBy 2014, via

•37 GP practices•The Healthy Hoose (Aberdeen)•Community pharmacies•Aberdeen Sports Village• Integrated Services Alcohol & Drug Partnerships -Kessock Clinic (Fraserburgh) -Turning Point Scotland (Peterhead; Elgin) -Timmermarket Clinic (Aberdeen)•Community Hospitals (Leanchoil, Forres; Fraserburgh; Peterhead)•Gypsy Traveller sites•Employment Programmes (Peterhead; Banff)•Aberdeen Health & Care Village•Prisons (HMP Aberdeen;HMP Peterhead); HMP & YOI Grampian•Royal Cornhill Hospital

…where delivered?Increasingly varied

Delivery Model 2008/09 2009/10 2010/11 2011/12 2012/13 2013/142014/15

GP practice 213 1018 1460 1352 1453 1600 267

Pharmacy 128 208 105 85 8

Substance Misuse Clinics 35 44 3

Carer Initiative 21 11 13

Income Deprived Initiative 8 8 7

Homeless Initiative 3 7 3

Gypsy/Traveller Event 5 10 0

Prison 0 22 0

Criminal Justice 0 2 1

Healthy Working Lives 6 48

Other 183 3 0 0

TOTAL 213 1018 1771 1560 1633 1795 350

Learning......21,900 patients eligible

16,561 invited

6,032 attended

Data from this cohort is held in the Keep Well Business Objects Universe (BOU). The following analyses are based on the BOU.

.....uptake........36% of patients who were invited, attended a health check.

.....invitation....And the method of invitation is important....

Health checks......Inequalities-targeting is effective – majority are from the most deprived quintiles

....health checks......

...health checks........•Equal proportion of males and females•69% White Scottish•249 carers•150 patients from the homeless practice•441 patients from ethnic vulnerable groups

...health checks.......Employment status

Clinical data23% had blood pressure greater than 140/90

...clinical data.....Men more likely to have high BP than women (26% vs 19%)And for SIMD

....clinical data....57% had a total cholesterol level >5

...clinical data...Women more likely to have high cholesterol than men (60% vs 53%)And for SIMD

...clinical data...72% had a Body Mass Index of 25 or more% with high BMI increases with ageMen and women similar

...clinical data...ASSIGN CVD risk score is a key element of Keep Well15% of patients had high risk – ie 20% or greater chance of a CVD event within the next 10 years

...clinical data...% of patients with high risk increases with age

...clinical data...A greater % of men have high risk (17% vs 12% for women)And for SIMD

...clinical data...National Indicator 4: Number who have had at least one new chronic disease identified within 3 months of their most recent health check

2012/13(1307 hc)

2013/14(1374 hc)

Diabetes 14 12CHD 0 0Hypertension 15 13

Health behaviour data38% were smokers

...health behaviour data...

...health behaviour data...30% met current guidance of 30 minutes moderate activity 5 days a week

...health behaviour data...Men were more likely to meet activity guidelines than women (35% vs 25%)And by SIMD

...health behaviour data...Record of alcohol consumption....

...referrals...•Formal referrals resulting from health checks are very low •Only 1-2% of patients at health checks are recorded as being referred to other services

•These findings are consistent with those from other Health Board areas

...advice...However, advice is more commonly recorded, eg•67% of smokers given smoking cessation advice•% of all health checked patients who have been given on advice :•Alcohol 9%•Activity 21%•Diet 42%

Review patients

Still enjoys moderate exerciseContinues to be a light drinkerSmoker

‘Kate Wells’ had a health check in 2008 and a review health check in 2013White ScottishAged 46 Lives in George St areaWorkingReceived low income benefit in ‘08

Kate '08 '13

BMI 27 27

BP 108/70 110/70

Cholesterol 8.4 7.3

ASSIGN Score 7 12

Review patients

Enjoyed light exercise in ‘08, but now moderateContinues to be a light drinkerEx-smoker

‘Keith Weller’ had a health check in 2008 and a review health check in 2013White ScottishAged 47 Lives in NorthfieldWorkingReceived sickness/invalidity benefit in ‘08

Keith '08 '13

BMI 37.6 34

BP 150/100 130/82

Cholesterol 4.5 3.8

ASSIGN Score 8 7

Review patients

Activity advice – ‘walks dogs, plays badminton and swims weekly as well’Diet advice – ‘diet seems quite healthy says biscuits downfall but now changed to crackers and attending Healthy Helpings at Woodend wife likes to cook processed meals, discussed fresh cooked meals says will start cooking fresh meals himself’

‘Keith Weller’ had a health check in 2008 and a review health check in 2013

There was no evidence – at either health check – that Keith had been referred, or even been given advice

However, subsequent to his review health check, some advice WAS recorded:

Key Findings•Before Keep Well..two thirds had visited GP practice within previous 12-18 months•At invitation..uptake is 36% - however, twice as successful if invitation is in person or by phone•Inequalities-targeted programme reaches target•At health checks...the majority•White Scottish, employed•High BMI•High cholesterol•Ex or non-smokers•Do not meet activity guidelines•Referrals are minimal. Advice is more likely