Keep Well Evidence from the Keep Well programme in NHS Grampian – 2008 to 2014 Jackie Fleming Keep Well Information Analyst

What is Keep Well? Inequalities-targeted national programme In NHSG since 2008…..in Aberdeen City and Moray (Well North) Health checks covering Clinical AND health behaviour AND life circumstances Anticipatory care CVD risk screening (ASSIGN) Referral and signposting

Eligibility for Keep Well Core group age 40-64, and living in deprived areas Vulnerable groups South Asian (35-64) Black Afro-Caribbean (35-64) Gypsy Travellers (18-64) Substance misusers (18-64) Homeless (18-64) Criminal Justice (18-64)

Eligibility for Keep Well Core group age 40-64, and living in deprived areas identified using the Scottish Index of Multiple Deprivation (SIMD) Preliminary work gave GP practices a profile of their Keep Well patients: More than two thirds had had a surgery consultation within the previous months

Where is Keep Well delivered? In 2008/09, via 5 GP practices By 2014, via 37 GP practices The Healthy Hoose (Aberdeen) Community pharmacies Aberdeen Sports Village Integrated Services Alcohol & Drug Partnerships -Kessock Clinic (Fraserburgh) -Turning Point Scotland (Peterhead; Elgin) -Timmermarket Clinic (Aberdeen) Community Hospitals (Leanchoil, Forres; Fraserburgh; Peterhead) Gypsy Traveller sites Employment Programmes (Peterhead; Banff) Aberdeen Health & Care Village Prisons (HMP Aberdeen;HMP Peterhead); HMP & YOI Grampian Royal Cornhill Hospital

…where delivered? Increasingly varied Delivery Model2008/092009/102010/112011/122012/132013/142014/15 GP practice Pharmacy Substance Misuse Clinics Carer Initiative Income Deprived Initiative 887 Homeless Initiative 373 Gypsy/Traveller Event 5100 Prison 0220 Criminal Justice 021 Healthy Working Lives 648 Other TOTAL

Learning ,900 patients eligible 16,561 invited 6,032 attended Data from this cohort is held in the Keep Well Business Objects Universe (BOU). The following analyses are based on the BOU.

.....uptake % of patients who were invited, attended a health check.

.....invitation.... And the method of invitation is important....

Health checks Inequalities- targeting is effective – majority are from the most deprived quintiles

....health checks......

...health checks Equal proportion of males and females 69% White Scottish 249 carers 150 patients from the homeless practice 441 patients from ethnic vulnerable groups

...health checks Employment status

Clinical data 23% had blood pressure greater than 140/90

...clinical data..... Men more likely to have high BP than women (26% vs 19%) And for SIMD

....clinical data % had a total cholesterol level >5

...clinical data... Women more likely to have high cholesterol than men (60% vs 53%) And for SIMD

...clinical data... 72% had a Body Mass Index of 25 or more % with high BMI increases with age Men and women similar

...clinical data... ASSIGN CVD risk score is a key element of Keep Well 15% of patients had high risk – ie 20% or greater chance of a CVD event within the next 10 years

...clinical data... % of patients with high risk increases with age

...clinical data... A greater % of men have high risk (17% vs 12% for women) And for SIMD

...clinical data... National Indicator 4: Number who have had at least one new chronic disease identified within 3 months of their most recent health check 2012/13 (1307 hc) 2013/14 (1374 hc) Diabetes1412 CHD00 Hypertension1513

Health behaviour data 38% were smokers

...health behaviour data...

30% met current guidance of 30 minutes moderate activity 5 days a week

...health behaviour data... Men were more likely to meet activity guidelines than women (35% vs 25%) And by SIMD

...health behaviour data... Record of alcohol consumption....

...referrals... Formal referrals resulting from health checks are very low Only 1-2% of patients at health checks are recorded as being referred to other services These findings are consistent with those from other Health Board areas

...advice... However, advice is more commonly recorded, eg 67% of smokers given smoking cessation advice % of all health checked patients who have been given on advice : Alcohol 9% Activity 21% Diet 42%

Review patients Still enjoys moderate exercise Continues to be a light drinker Smoker ‘ Kate Wells’ had a health check in 2008 and a review health check in 2013 White Scottish Aged 46 Lives in George St area Working Received low income benefit in ‘08

Review patients Enjoyed light exercise in ‘08, but now moderate Continues to be a light drinker Ex-smoker ‘ Keith Weller’ had a health check in 2008 and a review health check in 2013 White Scottish Aged 47 Lives in Northfield Working Received sickness/invalidity benefit in ‘08 Keith'08'13 BMI BP150/100130/82 Cholesterol ASSIGN Score87

Review patients Activity advice – ‘walks dogs, plays badminton and swims weekly as well’ Diet advice – ‘diet seems quite healthy says biscuits downfall but now changed to crackers and attending Healthy Helpings at Woodend wife likes to cook processed meals, discussed fresh cooked meals says will start cooking fresh meals himself’ ‘ Keith Weller’ had a health check in 2008 and a review health check in 2013 There was no evidence – at either health check – that Keith had been referred, or even been given advice However, subsequent to his review health check, some advice WAS recorded:

Key Findings Before Keep Well..two thirds had visited GP practice within previous months At invitation..uptake is 36% - however, twice as successful if invitation is in person or by phone Inequalities-targeted programme reaches target At health checks...the majority White Scottish, employed High BMI High cholesterol Ex or non-smokers Do not meet activity guidelines Referrals are minimal. Advice is more likely