TheTayside Cardiology Unmet Needs Project (PDF Poster ...

HI 013
Community Heart:The Tayside Cardiology Unmet Needs Project
Authors: A Hume,T Byres, J Doddy, M Belcher, C Martin, A Eriksen, F Sullivan, S Pringle
Lead Contact: Professor Stuart D Pringle, Cardiology Department, Ninewells Hospital, Dundee
DD1 9SY,Tel: 01382 632263, E-mail: stuart.pringle@nhs.net
Organisation: NHS Tayside
Aim:
Despite recent improvements in healthcare,
inequity of access due to socio-economic and
ethnic factors remains a problem. In cardiology,
some patients with the highest clinical need
have difficulty accessing specialist services.The
aim of this project was to investigate different
ways of engaging with patients and their
communities to address this problem.
Methodology:
The clinical team, overseen by a multidisciplinary
steering group, comprised two specialist nurses,
a cardiac physiologist and a consultant
cardiologist with additional support from a data
facilitator and project administrator. Multiple
methods of patient identification were
employed. Hospital sector clinical IT systems
were analysed for patients from post code areas
with deprivation category 6 and 7 who had
failed to attend outpatient appointments,
defaulted from cardiac rehab or had known
acute coronary events but no further
investigation or hospital contact. In primary care,
the practice-based disease registers were
examined to find patients with a clinical
diagnosis of heart failure or angina who had not
had cardiac investigations or specialist referral.
Communities were engaged with by attending
organised social, educational and religious events
in community centres, temples, church halls, and
mosques including a feature on Ramadan Radio.
Additional screening opportunities were
provided at community gala days, shopping
centres, the city square and a bingo hall. At
clinics carried out in these non-healthcare
facilities and in an adapted lorry, the patients
had a clinical evaluation with a consultant
cardiologist, 12 lead ECG, near patient blood
testing and portable echocardiography. Patients
requiring stress ECG or more specialised cardiac
imaging had these tests arranged at the hospital.
Outcomes/Results:
Of the 1781 people seen so far 1632 had
clinical evaluation and 252 needed specialist
cardiology assessment or heart failure review.
Very few required subsequent coronary
angiography (n=8) with a view to coronary
revascularisation but this was offset by a high
proportion of the cardiology patients (48%)
requiring a review of their diagnosis or change
in medication.
Conclusions:
By engaging with these communities, employing
multiple search strategies and providing
opportunistic health screening it is possible to
identify patients who find themselves excluded
from cardiology services due mainly to their
socio-economic or ethnic minority status, and
offer them specialist assessment in
predominately non-healthcare and innovative
mobile facilities closer to their home.
Health Improvement