Y&H Atrial Fibrillation Stroke Prevention Programme Tony Jamieson 2016/17

The problem In excess of 20,000 patients with AF across Y&H are at risk of stroke and are not being protected by an anticoagulant. There are over 300 strokes a year that could be prevented by anticoagulation. That is 300 people who will suffer life long disability or die, needlessly. These stokes will cost the NHS in Y&H in excess of £3.5 million a year. AF affects 2.4% of the adult population and prevalence is increasing with the aging population.

Financial Balance – Tough decisions Prioritising patients with a CHADSVASC score of > 4. Treating 100 patients will prevent 12 strokes each year, save 4 lives and avoid 2 people entering residential care. This will save £31,433 in NHS spend and £7,127 excess social care costs. Assuming 75% choose Warfarin and 25% choose DOAC. That is £9,375 pa for warfarin (£125 pp) and £19,500 (£780 pp) That saves aprox £2,500 for the NHS, saves 4 lives, and reduces the burden on social services, in year and recurring every year.

What’s to do. We know what needs to be done: “Offer anticoagulation to patients with AF and a CHADSVASC ≥ 1” Get patients to accept anticoagulation. Get them to adhere to anticoagulation. Keep them safe on anticoagulation. Progress is being made but for some reason this is proving difficult.

Y&H AHSN Proposal Tackle the problem differently finding practice driven solutions. Starting with the familiar – PRIMIS GRASP-AF (or local equivalent) And introducing new approaches: Evidence based psychological approaches to clinical behaviour change And Proven Institute of Health Improvement method of quality improvement

Coaching for improvement Audit Tools Detection methods Quality Improvement Behaviour Change Warfarin Safety Tool GRASP-AF PRIMIS Pulse Checks & Diagnostic Devices Plan – Do – Study – Act cycles Run Charts. Reducing psychosocial barriers to change

How it works.

Who does what? Engagement can be customised to the local needs. We can work with CCGs, federations, or individual practices. We will train coaches in PRIMIS audit tools, the Achieving Behaviour Change Toolkit and Quality Improvement methods. We can provide coaches for a limited number of practices across Y&H We will support coaches to work with GP practices to apply the PRIMIS tools, behaviour change interventions and plan-do-study-act cycles for improvement. We will work together to measure and monitor improvement.

Our Toolkit

Don’t wait to Anticoagulate Proven Quality Improvement Programme Developed and tested by West of England Academic Health Science Network Started in 11 innovator practices Now across 81 practices in Gloucester CCG

What is expected? To create your own coaches you will need to release one person for every 10 practices involved for: 1 ½ days off site training in PRIMIS tools 1 days off site training in Achieving Behaviour Change 2 hours of on-line QI training 1 day’s off site training in QI An average of 10 hours per week coaching time. You will also need to collect the (anonymised) data from the practices to monitor progress.

In the practice The practices involved will need: A small group of staff to complete the on-line QI training and act as the ‘instruments of change’ To complete plan-do-study-act tests of changes. These are generally small scale tests which can be scaled up if they work. Do a weekly search of the GP system to extract the improvement measure data. Talk to or meet the coach each week.

Example Time line January 2017 Sign-up February – April 2017 Training, PRIMIS & Case finding May –September 2017 Quality Improvement October 2017 Evaluation

Costs This is a £55,000 programme which is free to the participants*. The Y&H AHSN is funding the programme and is receiving support for the programme from: Daichii Sankyo, Bayer (who are primarily supporting the QI element of the programme) Pfizer/BMS (who are primarily supporting the Community Pharmacy element of the programme) Boehringer Ingelheim (who are supporting the PRIMIS element of the programme and shared decision making). The full details of this support will be published on our website. * The Y&H AHSN does not fund back-fill or travel costs for participation in the programme.

Next Steps Express your interest by e-mailing tony.jamieson@yhahsn.com Identify your coaches, or request support from our coaches. Identify your target practices. Get your corporate sign off…if you need it.