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3. What will
HaHP do to achieve its intended
outcomes?
The intended outcomes will either generate new
knowledge, or take existing knowledge and develop it
further in its application.
Intended outcomes
Dimension A
A1 A Central Data Repository (
CDR) that enables implementation of a
targeted primary prevention system through primary
care.
A2 A primary prevention intervention for
Paisley residents aged 45-60 years that effectively reduces
the targeted population's risk of cardiovascular
disease.
Dimension B
B1 A
CDR that enables implementation of a
targeted secondary prevention system through primary
care.
B2 Improvement of the cardiovascular
health of Paisley residents who already have identified
coronary heart disease and who are currently maintained in
primary care.
B3 Delivery of effective 'phase III'
cardiac rehabilitation (comprising structured exercise and
other risk factor modification) in a community setting for
appropriate patients. At the same time a safe and effective
cardiac rehabilitation service is designed for the highest
risk patients (
i.e. the most ill
CHD patients) who are referred to the
cardiac rehabilitation programme at the Royal Alexandra
Hospital, Paisley.
Dimension C
C1 Maximum participation of target
population in both A and B interventions using a social
marketing approach and innovative community planning
workforce development.
C2 Influence on wider policy and practice
through dissemination of learning/lessons from
HaHP.
Central Data Repository (
CDR)
The
IT based Central Data Repository (
CDR), successfully developed in Phase 1
will play an important role in Phase 2. Drawing on
population data, services can be directed to those most in
need and the
CDR will work as a powerful public
health tool in helping to address health inequalities
relating to life circumstances. The current policy context
in Scotland promotes greater responsiveness to patient
needs and it is proposed that an equity audit be carried
out in Paisley with a view to improving access and services
to vulnerable populations and to promote patient
involvement. The
CDR will enable multi-practice audits to
examine equity between population groups as well as between
practices. Annex 2 provides further information on the
functioning of the
CDR.
Dimension A
Evidence
- Recent research suggests that
CHD registers in primary care
settings can impact positively on patient care and
outcomes. In these settings, evidence exists that
CHD registers have supported
evidence-based practice and favourable health outcomes.
However, while some of the potential benefits of
CHD registers have been identified,
further work is required to determine how the
HaHPCDR can support changes in risk
factor management and clinical decision-making.
- The 2004 Department of Health (DoH) public health
White Paper, Choosing Health: Making Healthy Choices
Easier, states that:
- evidence supports a health trainer
role in helping people to change and maintain healthier
lifestyles
- the 'self-care' or 'expert patient'
approach has been successful with people who are ill
and that this approach should be expanded into the
prevention field enabling people to take greater
control of their own health
- further inequalities in health can
be prevented through identifying people who may be at
risk of developing chronic diseases or supporting
people with existing chronic conditions. This sort of
approach has been shown to be effective in work with
people in their 50s - an age at which people often
begin to experience illnesses that can develop into
chronic disease and is a time when people's motivation
to improve their own health increases.
- Much of what the DoH proposes fits with the
HaHP Phase 2 approach for Dimensions
A and B.
HaHP proposed a health coach
approach prior to the launch of the White Paper and
subsequently used the DoH's description of the health
trainer to develop further its own health coach
concept.
Intervention
- The Central Data Repository will be used to support
the delivery of a targeted primary prevention
intervention through primary care. The
CDR extracts all relevant data from
the
GPASS systems.
A primary prevention intervention will be designed and
implemented for people aged 45-60, with the intention of
reducing that population's risk of cardiovascular disease.
For deprived communities staff from an
NHS Argyll and Clyde unmet need pilot
project, funded by the Scottish Executive, will work with
staff from
HaHP to increase uptake through the use
of community development approaches. Individual
participants will have their cardiovascular risk score
calculated. Those found to be at increased risk will be
offered a service that helps reduce their risk through a
model of health coaching. Those whose scores do not
indicate increased risk will be given advice to help them
maintain their current low level of risk. People whose
individual scores do not suggest increased risk but who
live in area with Depcats 6 or 7 will be offered a positive
mental health promotion intervention. This component will
be developed subject to the recommendations of a systematic
review of positive psychology literature that will be
completed by the Glasgow Centre for Population Health early
in 2006.
In the first six months of Phase 2 a mapping exercise
and needs assessment will be carried out that will enable
identification of current services and opportunities in
Paisley in relation to
CHD risk factors and identify the
service needs of the target population (45-60 year olds).
This will subsequently inform the decision process around
the development of interventions and services required to
strengthen the overall preventive effort in Phase2.
Health coaching will engage those at risk in the target
population, help maintain them on their planned lifestyle
changes and plan with the individual how they will adhere
to this on a long-term basis including sign-posting to
other relevant services, as identified by the mapping
process. This will include sign-posting to local alcohol
services should that be found to be required. Questions
around alcohol consumption will be asked as part of the
enquiry relating to diet with health coaches having a basic
level of knowledge and understanding about alcohol and its
impact on health.
A lay mentoring approach will also be used within
communities to aid healthy lifestyle promotion in relation
to tobacco, physical activity and healthy eating, helping
to overcome some of the barriers that this target group
faces through empowerment and support. Evaluation of this
approach will add to the evidence base in this largely
untested area.
Health coaching roles and staff numbers will be
clarified by October 2005. A competency framework for
health coaching along with innovative workforce development
will be developed with
NHS Education Scotland,
NHS Health Scotland and others. The
workforce is likely to be drawn from
HaHP development staff, Unmet Need
staff, lay mentors,
NHS and local authority staff. This
training approach will inform any additional recruitment
requirements of the health coaching role/function.
In year 1 a computer based Health Behaviour Change
Network (
HBCN) will be developed that will
capture details of all the available services in a web
based tool that can be used by the Health Coaches to
signpost individuals to suitable services.
HaHP will work with the Big Lottery Fund
development of the
CHD and Stroke
MCNs on the Web project that is
seeking synergies with related health care projects.
Dimension B
Evidence
- The weight of evidence indicates that exercise-only
cardiac rehabilitation reduces all cause mortality by
27%, cardiac death by 31% and a combined end-point
mortality, non-fatal myocardial infarction and
revascularisation by 19%.
- Evidence is being sought as to whether it is
possible to create a systematic and integrated
programme to improve cardiovascular health for those
with existing heart disease.
- It has been found that effective and safe phase III
cardiac rehabilitation can be delivered in a community
setting. It is recommended for safe practice that
cardiac rehabilitation services for the highest risk
patients (
i.e. the most ill
CHD patients) should be delivered in
a hospital setting.
Intervention
- An intervention will be designed and implemented
that aims to improve the cardiovascular health of
patients who only attend primary care and already have
been identified with coronary heart disease. This will
engage the patients in comprehensive secondary
prevention and rehabilitation through the most
appropriate and desired setting using the health
coaching model. This rehabilitation will also include
support from trained lay mentors to encourage adherence
and give added social support.
- The cardiac rehabilitation service will be
redesigned to deliver menu-based phase III cardiac
rehabilitation in a community setting and provide a
safe and effective cardiac rehabilitation service for
the highest risk patients (
i.e. the most ill
CHD patients) in a hospital setting.
Successful delivery of this intervention requires
ongoing partnership working with the Local Authority
and other stakeholders to develop a broad range of
sustainable exercise opportunities.
Dimension C
Evidence
- It has been shown that the provision of information
and 'persuasive messages' (as in social marketing) can
increase individuals' knowledge of health risks and
appropriate action.
Intervention
- Help to deliver A and B through
social marketing approaches incorporating co-branding
of
HaHP and the national
Healthy Living campaign.
- Facilitate learning and development
for the target population and those providing
interventions based on lessons from Phase 1 and
expanding to include positive mental health and
wellbeing.
As Phase 2 of
HaHP will concentrate on building the
capacity of both the target group identified and that of
partners who can help facilitate heart health change, there
will be considerable emphasis on education and learning
within these distinct areas. The project will work closely
with Renfrewshire Council on their developing 'Community
Learning and Development Strategy' and in integrating
HaHP learning with the local Community
Learning Plans. Workforce development activity will be
aimed at those working within the direct and wider
HaHP field to deliver Phase 2 of the
project. The purpose of this area is to build the capacity
of community planning partners in relation to heart health
promoting needs.
A training needs assessment will take place at the start
of Phase 2 and solutions generated to support the capacity
of these professionals according to need and setting. This
could include topics such as
CHD awareness and risk factors for non
health related staff, or motivational interviewing for
those performing a health coaching role.
- Influence policy and practice through dissemination
of learning from Phase 1, the Transition Phase and
Phase 2 as it progresses.
The following organisations have been identified as
potential agents for enabling capacity building in respect
of Dimension C:
a) Social Marketing:
- Local press and media
- Liaison with National Healthy Living Campaign
- ASH Scotland
- Scottish Executive - Press Health Team
- NHS Health Scotland
- Scottish Community Diet Project
- National Physical Activity Co-ordinator
b) Education/Learning:
- Community Learning & Development within
Renfrewshire Council
- Integrated Community Schools within Renfrewshire
Council
- NHS Argyll and Clyde Learning and
Development
- Paisley University and Reid Kerr College
- Local education centres (
e.g. adult learning centres,
RCVS)
- NHS Health Scotland
- NHS Education Scotland
- Centre for Confidence and Wellbeing
c) Dissemination
- NHS Health Scotland - Heart Health
Learning Network
- All local contacts listed above in a) and b)
- National organisations (
e.g.BHF,
COSLA,
CHSA, Diabetes
UK, Heart of Mersey,
Braveheart)
Annex 3 gives further details on the planned activity
for Dimensions A, B and C.
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