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Appendix F. Greater Glasgow Health Board - Chronic Disease Management Programme in Primary Care
Topics: Mental Health; Primary Care;
Background
Coronary Heart Disease ( CHD) is the leading cause of death and morbidity in Glasgow and is associated with high levels of risk factors and increasing levels of deprivation. Secondary prevention can substantially reduce the risk of myocardial infarction and progression of CHD once it is diagnosed.
Funding allocation
The pilot was allocated £2,130,000
Aim(s)
To reduce coronary heart disease ( CHD) through a systematic approach to secondary prevention that focuses, not only on using the medical model, but also gives attention to other risk factors that can contribute to risk reduction.
Methodology
The Locally Enhanced Services ( LES) in Greater Glasgow ensures a systematic approach to secondary prevention, not only using the medical model but also attention to other health risks that can contribute to risk reduction. Depression or other mental health problems which limit a person's ability to make lifestyle changes are also addressed within the programme.
The programme includes provision of training and resources for practice staff, development of patient pathways, cardiac rehabilitation, liaison with mental health services and robust monitoring systems.
Key results
Some of the key findings from the evaluation of the programme include:
- The analysis of LES data shows that there is a relatively shallow social gradient of CHD prevalence when all ages are combined but there is a much steeper gradient in younger age groups in which the main burden of premature CHD mortality and morbidity is found
- There is a 29% excess caseload of CHD patients per WTEGP working in the most deprived fifth of the population
- Although data were only available for a quarter of patients with CHD, there is strong socio-economic patterning in the prevalence of anxiety and depression suggesting that CHD diagnoses in patients in deprived areas are associated with increased psychological morbidity
- Therefore, both the increased caseload and associated co-morbidity are likely to affect the quality of care that is provided for CHD patients in deprived areas.
Conclusions
Further work is required to describe the implications of the findings on the quality and outcome of care provided for CHD patients in different settings.
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