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Innovation in clinical specialities: cardiovascular disease References continued recent decline in mortality from coronary heart disease, 1980-1990. The effect of secular trends in risk factors and treatment. JAMA 1997;277:535-42. PMID:9032159 doi:10.1001/jama.277.7.535 10. Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in mortality from coronary heart disease in the United States between 1980 and 2000. N Engl J Med 2007;356:2388-98. PMID:17554120 doi:10.1056/NEJMsa053935 11. Weinstein MC, O’Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al. Principles of good practice for decision analytic modeling in health-care evaluation: report of the ISPOR Task Force on Good Research Practices – Modeling Studies. Value Health 2003;6:9-17. PMID:12535234 doi:10.1046/j.1524-4733.2003.00234.x 12. Goldman L, Phillips KA, Coxson P, Goldman PA, Williams L, Hunink MG, et al. The effect of risk factor reductions between 1981 and 1990 on coronary heart disease incidence, prevalence, mortality and cost. J Am Coll Cardiol 2001;38:1012-7. PMID:11583874 doi:10.1016/S0735-1097(01)01512-1 13. Rose G. The strategy of preventive medicine. Oxford: Oxford University Press; 1992. 14. Emberson J, Whincup P, Morris R, Walker M, Ebrahim S. Evaluating the impact of population and high-risk strategies for the primary prevention of cardiovascular disease. Eur Heart J 2004;25:484-91. PMID:15039128 doi:10.1016/j.ehj.2003.11.012 Publication: Bulletin of the World Health Organization; Type: Policy and Practice Article DOI: 10.2471/BLT.08.057885 15. McPherson K, Britton A, Causer L. Coronary heart disease: estimating the impact of changes in risk factors. London: National Heart Forum; 2002:1-60 16. Capewell S, Beaglehole R, Seddon M, McMurray J. Explanation for the decline in coronary heart disease mortality in Auckland, New Zealand, between 1982 and 1993. Circulation 2000;102:1511-6. PMID:11004141 17. Unal B, Critchley JA, Capewell S. Explaining the decline in coronary heart disease mortality in England and Wales between 1981 and 2000. Circulation 2004;109:1101-7. PMID:14993137 doi:10.1161/01.CIR.0000118498.35499.B2 18. Laatikainen T, Critchley J, Vartiainen E, Salomaa V, Ketonen M, Capewell S. Explaining the decline in coronary heart disease mortality in Finland between 1982 and 1997. Am J Epidemiol 2005;162:764-73. PMID:16150890 doi:10.1093/aje/kwi274 19. Critchley J, Liu J, Zhao D, Wei W, Capewell S. Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999. Circulation 2004;110:1236-44. PMID:15337690 doi:10.1161/01.CIR.0000140668.91896.AE 20. Bots ML, Grobbee DE. Decline of coronary heart disease mortality in the Netherlands from 1978 to 1985: contribution of medical care and changes over time in presence of major cardiovascular risk factors. J Cardiovasc Risk 1996;3:271-6. PMID:8863098 doi:10.1097/00043798-199606000-00002 21. Vartiainen E, Puska P, Pekkanen J, Tuomilehto J, Jousilahti P. Changes in risk factors explain changes in mortality from ischaemic heart disease in Finland. BMJ 1994;309:23-7. PMID:8044063 22. Critchley JA, Capewell S. Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels. J Epidemiol Community Health 2003;57:243-7. PMID:12646537 doi:10.1136/jech.57.4.243 23. Unal B, Critchley JA, Capewell S. Small changes in UK cardiovascular risk factors could halve coronary heart disease mortality. J Clin Epidemiol 2005;58:733-40. PMID:15939226 doi:10.1016/j.jclinepi.2004.09.015 24. Stamler J, Stamler R, Neaton JD, Wentworth D, Daviglus ML, Garside D, et al. Low riskfactor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA 1999;282:2012-8. PMID:10591383 doi:10.1001/jama.282.21.2012 25. Daviglus ML, Stamler J, Pirzada A, Yan LL, Garside DB, Liu K, et al. Favorable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality. JAMA 2004;292:1588-92. PMID:15467061 doi:10.1001/jama.292.13.1588 26. Unal B, Critchley J, Capewell S. IMPACT, a validated comprehensive coronary heart disease model: overview & technical appendices. Liverpool: Liverpool University; 2007. Available from: http://www.liv.ac.uk/PublicHealth/sc/bua/impact.html [accessed on 5 October 2009]. 27. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937-52. PMID:15364185 doi:10.1016/S0140-6736(04)17018-9 Publication: Bulletin of the World Health Organization; Type: Policy and Practice Article DOI: 10.2471/BLT.08.057885 28. Briggs A, Sculpher M, Buxton M. Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis. Health Econ 1994;3:95-104. PMID:8044216 doi:10.1002/hec.4730030206 29. Naidoo B, Thorogood M, McPherson K, Gunning-Schepers LJ. Modelling the effects of increased physical activity on coronary heart disease in England and Wales. J Epidemiol Community Health 1997;51:144-50. PMID:9196643 doi:10.1136/jech.51.2.144 30. Capewell S. Predicting future coronary heart disease deaths in Finland and elsewhere. Int J Epidemiol 2006;35:1253-4. PMID:16847019 doi:10.1093/ije/dyl158 31. Capewell S, Unal B, Critchley JA, McMurray JJ. Over 20 000 avoidable coronary deaths in England and Wales in 2000: the failure to give effective treatments to many eligible patients. Heart 2006;92:521-3. PMID:16537767 doi:10.1136/hrt.2004.053645 32. Daviglus ML, Liu K. Today’s agenda: we must focus on achieving favorable levels of all risk factors simultaneously. Arch Intern Med 2004;164:2086-7. PMID:15505120 doi:10.1001/archinte.164.19.2086 33. Hozawa A, Folsom AR, Sharrett R, Chambless LE. Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects - Atherosclerosis Risk in Communities Study. Arch Intern Med 2007;167:573-9. PMID:17389288 doi:10.1001/archinte.167.6.573 34. Manuel DG, Kwong K, Tanuseputro P, Lim J, Mustard CA, Anderson GM, et al. Effectiveness and efficiency of different guidelines on statin treatment for preventing deaths from coronary heart disease: modelling study. BMJ 2006;332:1419-24. PMID:16737980 doi:10.1136/bmj.38849.487546.DE 35. Capewell S. Will screening individuals at high risk of cardiovascular events deliver large benefits? No. BMJ 2008;337:a1395 PMID:18755771 doi:10.1136/bmj.a1395 36. Dowse GK, Gareeboo H, Alberti KG, Zimmet P, Tuomilehto J, Purran A, et al. Changes in population cholesterol concentrations and other cardiovascular risk factor levels after five years of the non-communicable disease intervention programme in Mauritius. Mauritius Non-communicable Disease Study Group. BMJ 1995;311:1255-9. PMID:7496233 37. Carroll MD, Lacher DA, Sorlie PD, Cleeman JI, Gordon DJ, Wolz M, et al. Trends in serum lipids and lipoproteins of adults, 1960. JAMA 2005;294:1773-81. PMID:16219880 doi:10.1001/jama.294.14.1773 38. Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, American Heart Association Nutrition Committee, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the AHA Nutrition Committee. Circulation 2006;114:82-96. PMID:16785338 doi:10.1161/CIRCULATIONAHA.106.176158 39. Framework Convention for Tobacco Control [internet site]. Geneva: World Health Organization; 2004. Available from: http://www.who.int/fctc/en/ [accessed on 5 October 2009]. 40. Fichtenberg CM, Glantz SA. Association of the California Tobacco Control Program with declines in cigarette consumption and mortality from heart disease. N Engl J Med 2000;343:1772-7. PMID:11114317 doi:10.1056/NEJM200012143432406 Publication: Bulletin of the World Health Organization; Type: Policy and Practice Article DOI: 10.2471/BLT.08.057885 41. Pell JP, Haw S, Cobbe S, Newby DE, Pell AC, Fischbacher C, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008;359:482-91. PMID:18669427 doi:10.1056/NEJMsa0706740 42. Tunstall-Pedoe H, Connaghan J, Woodward M, Tolonen H, Kuulasmaa K. Pattern of declining blood pressure across replicate population surveys of the WHO MONICA project, mid-1980s to mid-1990s, and the role of medication. BMJ 2006;332:629-35. PMID:16531419 doi:10.1136/bmj.38753.779005.BE 43. He FJ, MacGregor GA. How far should salt intake be reduced? Hypertension 2003;42:1093- 9. PMID:14610100 doi:10.1161/01.HYP.0000102864.05174.E8 44. Havas S, Roccella EJ, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium. Am J Public Health 2004;94:19-22. PMID:14713688 doi:10.2105/AJPH.94.1.19 45. Dietary guidelines for Americans. Washington, DC: United States Department of Health and Human Services / Department of Agriculture; 2005. 46. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346:393-403. PMID:11832527 doi:10.1056/NEJMoa012512 47. Jain A. Treating obesity in individuals and populations. BMJ 2005;331:1387-90. PMID:16339251 doi:10.1136/bmj.331.7529.1387 48. Craig CL, Russell SJ, Cameron C, Bauman A. Twenty-year trends in physical activity among Canadian adults. Can J Public Health 2004;95:59-63. PMID:14768744 49. Tudor-Smith C, Nutbeam D, Moore L, Catford J. Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasiexperimental comparison of results from Wales and a matched reference area. BMJ 1998;316:818-22. PMID:9549451 50. Unal B, Critchley J, Fidan D, Capewell S. Life-years gained from modern cardiological treatments and population risk factor changes in England and Wales, 1981–2000. Am J Public Health 2005;95:103-8. PMID:15623868 doi:10.2105/AJPH.2003.029579 51. Brotman DJ, Walker E, Lauer MS, O’Brian RG. In search of fewer independent risk factors. Arch Intern Med 2005;165:138-45. doi:10.1001/archinte.165.2.138 Hospital and Healthcare Innovation Book 2009/2010 75
Innovation and clinical specialities: oncology The breast service psychosocial model of care project ARTICLE BY LAUREN K WILLIAMS PhD Research Fellow, Clinical Research Department, Melbourne IVF and The Royal Women’s Hospital, East Melbourne, Victoria, Australia G BRUCE MANN MB BS, PhD, FRACS Professor, University of Melbourne, and Director of The Breast Service, Royal Melbourne Hospital and Royal Women’s Hospital, Parkville, Victoria, Australia Objective: It has been consistently demonstrated that many women with breast disease will experience psychosocial distress at some stage along the patient journey. Psychosocial care has recently gained more prominence and is increasingly recognised as an important aspect of care offered to patients with breast cancer. The purpose of this project was to develop a model that improved the way psychosocial services were provided to patients. The aim of this paper is to describe the process in developing this psychosocial model of care for patients with breast disease. Methods: Using in-depth semi-structured interviews with a sample of patients and staff, we examined psychosocial concerns experienced by breast patients and the factors associated with the effective assessment and delivery of psychosocial care. The project was approved by the Royal Women’s hospital ethics secretariat as a quality assurance project. Results: An inductive analysis of staff responses indicated that a standardised screening and referral pathway was needed in a context of well defined staff roles and a multidisciplinary team environment. An inductive analysis of patient responses indicated that psychosocial concerns were common, but varied, and a tailored approach to the provision of psychosocial care was warranted. Discussion: In line with these findings, a standardised assessment and referral pathway was developed for The Breast Service that may be extended for use in other clinical settings and tumour streams. Over 12 000 women are diagnosed with breast cancer in Australia each year. 1 Unsurprisingly, psychosocial distress plays a significant role in the journey experienced by women diagnosed with this disease. Many of the common psychosocial concerns of women with breast cancer include body image disruption, sexual dysfunction, treatment-related anxieties, depression, marital/partner communication and relationship difficulties, and existential concerns regarding mortality. 2-4 Although many women will encounter and manage some degree of psychosocial distress following diagnosis, it is estimated that as many as 30% of women will experience episodes of persistent psychosocial distress that will interfere with their ability to cope with cancer treatment and life in general. 2,4 Psychosocial interventions such as support from a nurse/breast care nurse, exercise, telephone counselling, computer/online support, psychological and psychiatric care and social supports have all been found to improve the psychosocial status of women diagnosed with breast cancer. 5-7 As a result, the clinical practice guidelines from the National Health and Medical Research Council of Australia for the psychosocial care of adults with cancer 3 highlight the need for further research regarding “strategies to improve the detection of psychological difficulties in people with cancer” and “optimal methods for psychosocial referral and practice strategies to improve uptake”. Enhanced knowledge about the best way to detect and respond to patients’ psychosocial needs is vital in empowering and equipping health professionals with the necessary skills and resources to help patients with the range of psychosocial issues that arise along the breast cancer treatment continuum. Setting Recently, the Royal Women’s Hospital and Royal Melbourne Hospital breast services merged to form The Breast Service in an attempt to connect existing resources and provide a more comprehensive breast cancer service. Strategies to detect and respond to patients’ psychosocial needs were identified as a key priority area for The Breast Service. Before the merging of services, psychosocial care coordination differed between sites 76 Hospital and Healthcare Innovation Book 2009/2010
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