Post on 27-Dec-2015
transcript
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ANNUAL PUBLIC HEALTH REPORT 2011
Extending life in Islington
Harriet MurrellPublic Health Strategist.on behalf of Islington’s Public Health team
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To look at what more could be done to improve population health outcomes, and particularly early death, in people aged 18-74 living with long term conditions in Islington.
Four main sections:
– Description of the burden of ill-health from long term conditions
– Finding the undiagnosed
– Lifestyles and behaviour change in those with long term conditions
– Management and care of long term conditions in primary care
Case for change and recommendations on what more could be done to reduce early deaths and other outcomes in people living with long term conditions.
Purpose and outline
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High quality information to inform commissioning and service delivery
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Long term conditions in Islington: key areas for public health action
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Factors impacting on the prevalence of long term conditions
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SETTING THE SCENE: THE BURDEN OF ILL-HEALTH FROM LONG TERM CONDITIONS IN ISLINGTON
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Causes of death: 2006-08
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Numbers of long term conditions
Number of diagnosed long term conditions by condition, Islington’s registered population (18+), March 2011
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People living with multiple conditions
Number of diagnosed long term conditions per person aged 18-74 years, Islington’s registered population, March 2011
One condition(18,864)
Two conditions(6,277)
Three conditions
(2,078)
Four conditions
(664)
Five conditions(186)
Six or more conditions
(80)
Four or more conditions
(930)
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Comorbidity and order of diagnosis
SECOND DIAGNOSIS
FIR
ST
DIA
GN
OS
IS
n=
75
2
CHD
n=
3,8
02
42% 11% 10% 37%High blood pressure
n=
1,5
10
Diabetes 65% 8% 6% 21%
n=
33
4Stroke/TIA 56% 10% 8% 25%
n=
16
5
Atrial fibrillation 41% 13% 10% 36%
48% 19% 7% 27%
Other*
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Conditions with higher prevalence in deprived areas
Odds ratios and numbers of people diagnosed with long term conditions by type of condition and local deprivation quintiles, Islington’s registered population aged 18-74, March 2011
0
1
2
3
Psychotic disorders
CHD Chronic depression
Diabetes COPD
Od
ds
rati
o w
hen
co
mp
are
d w
ith
the
leas
t dep
rive
d (1
)
Long term condition
Least deprived
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This section looks at which lifestyle risk factors are important in contributing to the development of long term conditions in Islington with comparisons to early deaths. It also looks at differences by deprivation.
LIFESTYLES AND THE DEVELOPMENT OF LONG TERM CONDITIONS
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Contribution of lifestyle risk factors to long term conditions and early death
Contribution of lifestyle risk factors to the prevalence of and early deaths from diagnosed long term conditions, Islington’s registered population aged 18-74, March 2011
Smoking 18%
Overweight/obesity36%
Smoking6% Physical inactivity
4%
Low fruit& vegetable intake2%
Alcohol 2%
Smoking16%
Overweight/obesity10%
Low fruit& vegetable intake7%
Physical inactivity 5%
Alcohol2%
Impact on prevalence of long term conditions Impact on premature deaths due to long term conditions
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Smoking prevalence by ethnicity
Indirectly standardised ratio of smoking prevalence in those with diagnosed long term conditions by ethnic group, Islington’s registered population aged 18-74, March 2011
0
20
40
60
80
100
120
140
White Black Asian Other
Ind
irec
tly
stan
dar
dis
ed r
atio
of
smo
kin
g p
reva
len
ce in
tho
se w
ith
d
iag
no
sed
lon
g te
rm c
on
dit
ion
s
Ethnic group
Average
5,117 650 262 1,538
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Current lifestyle risk factors
Indirectly standardised prevalence of smoking, obesity and high and increasing risk drinking* among people with a diagnosed long term condition, Islington’s registered population aged 18-74, March 2011
*Increasing risk drinking is defined as usual consumption of between 22 and 50 units of alcohol per week for men, and between 15 and 35 units of alcohol per week for women. High risk drinking is defined as usual consumption of over 50 units of alcohol per week for men, and over 35 units of alcohol per week for women (APHO, 2010)
0
20
40
60
80
100
120
140
160
180
Smoking Ex-smoking Obesity Overweight High and increasing risk
drinking
Ind
irec
tly
stan
dar
dis
ed r
atio
of
pre
vale
nce
of r
isk
fact
or
Risk Factor
Persons with no long term condition Persons with one or more long term conditions
Average
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Diabetes and obesity
Indirectly standardised diagnosed prevalence of type II diabetes by BMI classification in adults aged 18-74, Islington registered population, March 2011
0
50
100
150
200
250
300
350
Underweight Healthy weight
Overweight Obesity Class I
Obesity Class II
Obesity Class III
Ind
irec
tly
stan
dar
dis
ed r
atio
of
dia
bet
es p
reva
len
ce
BMI group
Average
36 1,196 2,173 1,730 855 572
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Smoking and COPD
Current smoking status by MRC breathlessness scale in people aged 18-74 years diagnosed with COPD, Islington’s registered population, March 2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Per
cen
tag
e o
f peo
ple
wit
h C
OP
D
MRC Breathlessness Scale
Ex-smoker Smoker
100 148 298 312 243 267 133 124 24 22
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Missed opportunities to help to close prevalence gaps, better manage conditions, and to reduce early deaths.
SYSTEMATIC TARGETING OF THE POPULATION ‘AT RISK’ USING COST-EFFECTIVE INTERVENTIONS
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Follow-up of people with a high blood pressure reading but no diagnosis
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
200
400
600
800
1,000
1,200
1,400
35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
Per
cen
tag
e o
f peo
ple
wit
h a
hig
h b
loo
d
pre
ssu
re r
ead
ing
(lin
e)
Nu
mb
er o
f peo
ple
wit
h a
hig
h b
loo
d
pre
ssu
re r
ead
ing
(bar
s)
Age group
Dec 10 - Feb 11
Sep 10 - Nov 10
Dec 09 - Aug 10
Prior to Dec 09
% of total population
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NHS Health Checks and Cardiovascular risk assessments
Excludes Partnership Primary Care Centre because the clinical system uses Framingham CVD rather than QRisk2
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<10% 10-14% 15-19% ≥20% Not calculated
Per
cen
tag
e o
f peo
ple
in e
ach
ris
k b
and
Risk of heart attack or stroke/TIA in the next 10 years (QRisk2)
CVD risk assessment NHS Health Check CVD risk not assessed
50,634 7,335 3,593 4,590 8,648
931
667
965
3,152937
866
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Depression screening
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CHD and/or diabetes Long term condition other than CHD or diabetes
Per
cen
tag
e o
f peo
ple
wit
h a
dia
gn
ose
d
lon
g te
rm c
on
dit
ion
Depression screen only PHQ9 score
4,992
1,664
1,051607
Number and percentage of people with at least one diagnosed long term condition (excluding chronic depression and psychotic disorders) that have a record of
screening for depression or PHQ9 questionnaire, Islington’s registered population aged 18-74, March 2011
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Smoking advice offered to those with COPD
Smoking advice offered to people aged 18-74 with diagnosed COPD by MRC breathlessness scale, Islington’s registered population, March 2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Grade 1 Grade 2 Grade 3 Grade 4 Grade 5
Per
cen
tag
e o
f peo
ple
wit
h C
OP
D
off
ered
sm
oki
ng
hel
p
MRC Breathlessness Scale
169 378 342 161 36
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Prescribing
62129%
1,50771%
Not prescribedPrescribed
Antihypertensives
1,00161%
64739%
Not prescribedPrescribed
Statins
Percentage of eligible populations aged 18-74 years prescribed antihypertensives or statins in 2010/11, March 2011
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EXAMPLES OF SUCCESSES
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In 2010/11, Islington had the fourth highest rate of quits among all London boroughs, at 1,232 per 100,000 persons aged 16+.
There were a total of 5,940 attempts to quit with the Islington Stop Smoking Service, an increase on the 2009/10 figure (5,339).
The total number of quitters was 2,225, which exceeded the target number for this year (2,218).
Most quits (95%, 2,115) were achieved among GPs.
Only three Islington GP practices achieved lower quit rates per 1,000 practice population than the previous year. Five practices achieved a significantly higher rate.
Quit rates were significantly higher among the most deprived 20% of persons living in Islington than the least deprived 20%.
Smoking quits in Islington, 2010/11
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Overview of Health Checks in Islington, 2010/11
6,455 Health Checks (HCs) were carried out in Islington in 2010/11 in persons aged between 35 and 74, and with no previous relevant diagnosis.
7,637 HCs were offered (15% of the eligible population).
Most HCs were carried out at GP practices (62%, n=3,992), followed by the community outreach programme (27%, n=1,742) and pharmacies (n=721 HCs, 11%).
Islington was the only PCT in the NCL sector to achieve the target number of Health Checks delivered, and one of 8 PCTs in London to achieve this target. Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74; Health
Smart (May 2011); TeleHealth Solutions (June 2011).
0
500
1000
1500
2000
2500
3000
3500
4000
4500
GP practices Community Pharmacy
Nu
mb
er
of
He
alt
h C
he
ck
s
Number of NHS Health Checks, persons aged 35-74, Islington, 2010/11
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New diagnoses following Health Checks, 2010/11
Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population.
0
20
40
60
80
100
120
140
Hypertension Diabetes High cholesterol Other
Nu
mb
er
of
ne
w d
iag
no
se
s
Number of new diagnoses following HCs in Islington by sex, persons aged 35-74, Apr 2010 - Mar 2011
Women Men
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Time period
Recorded prevalenceExpected
prevalence
Undiagnosed prevalence
Number % Number %
2010/11 2,966 1.6%
3.7%
3,750 2.1%
2009/10 2,651 1.4% 4,240 2.3%
2008/09 2,579 1.4% 4,160 2.3%
Increase in diagnosed COPD
453 new diagnoses in the LES target population (patients aged >35, who were current smokers or ex-smokers) between April 2010 and March 2011.
The overall recorded prevalence has increased by 0.2 percentage points, thus reducing the gap of between expected and recorded prevalence by 13%.
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Next Steps
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Determining health and wellbeing priorities
Strategic fit (Must do’s; political influence)
Numbers of people affected by the issue and effect on health and wellbeing and health inequalities
Projected future position if no action taken
Benchmarking – how do we compare to other areas
Resource impact or cost to the community
Local views
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Current approaches to evidence in Islington
• The JSNA has been developed in two formats; a short version and a long version publicly available on the NHS Islington internet site http://www.islington.nhs.uk/jsna.htm
• PH intelligence pages contain quantitative data (NHS only)
• LBI webpages include top-line “borough statistics”
• Other information and performance reporting within internal systems, held by individual teams within different organisations
• Other evidence available from a range of different external organisations (e.g. PH observatories, NHS IC, Local Communities and Government
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Islington Evidence Hub
• Would include different types and levels of evidence to try and meet wide-ranging need for information – people can drill down for the level they require
• At a top-level: summary “factsheets” (e.g. Health Islington: the Facts; ward profiles; develop others for key themes); overarching performance metrics
• At bottom-level: access to spreadsheets with population counts
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Relationship with the Islington Health and Wellbeing Board
The evidence provided through the Joint Strategic Needs Assessment and other documents will support the work of the Islington Health and Wellbeing Board by clarifying the health and wellbeing needs of the local population.
Understanding the needs of the local population is important for informing the health and wellbeing priorities for the borough which in turn will influence strategy and commissioning decisions.