A historical perspective of CVD prevention in Greenwich

Jackie Davidson: Assistant Director of Public Health

In 2007/8 Greenwich

was one of 13 PCTs

(Baker’s Dozen),

which together made

up nearly 40% of the

mortality gaps, for

men and for women

Mortality reductions required to reduce

LE gap to target:

Compared to the number of deaths in

2008, there needed to be around 199

fewer deaths each year in Greenwich

to meet life expectancy target.

Understanding the high impact interventions

Clinical

• CVD- e.g. beta blocker, aspirin, ACE inhibitor, statin

• Hypertension (no CVD) – hypertensive therapy, statin

• AF-Anticoagulant therapy for > 65

• Diabetes- Reducing blood sugars (HbA1c)

• COPD treatment

Non-clinical

• Finding the missing

• Harmful drinkers- brief intervention

• Stop Smoking (longer term impact)

• NHS Health Checks (longer term impact)

The

“unaware”

missing

The

undiagnosed

The

excepted The at

risk

The

treated

The “hidden” missing

The

Healthy

Moving from prevention initiatives to

population sized prevention programmes

• To reduce the

variation between

Greenwich and

England/London/IMD

comparators -

“Raising the bar”

• To reduce the

variation between

Greenwich practices

Modelling the impact of the interventions

Greenwich LE (pre programme)

------ Trend for Greenwich LE

------ Increased LE due to better detection & management

……… Increased LE due to 3% Smoking Reduction

England LE

------- England Trend

Sharing data- the power of data

Sharing data-the power of data

Strategies to help find the missing- Practice Reports & visits

Having the conversation with practices

The data is wrong

The data is right but it is not a problem

The data is right, there is a problem but

it is not my problem

The data is right, I have a problem, what

can I do about it?

Strategies to help find the missing- Outreach

Impact of LTC Contract on prevalence

What have been the successes in Greenwich?

Creating a level playing field: reducing exception

reporting

Exception

Report

2007/8

CCG Rank

2008/9

CCG Rank

2014/15

CCG Rank

Overall 148/152 67/152 4/210

Diabetes 152/152 96/152 29/210

Hypertension 143/152 47/152 37/210

There are legitimate reasons for exception-reporting. But…………

6000000

6500000

7000000

7500000

8000000

8500000

9000000

9500000

10000000

Financial2009/2010

Financial2010/2011

Financial2011/2012

Financial2012/2013

Lipid-lowering prescribing (ADQs per year) 2009-2013

High Impact Area: Statins

In 3 Years lipid-lowering

medication prescribing

increased by 2242574

ADQs.

Equivalent to a

minimum of 6144

additional patients being

commenced on lipid

lowering medications.

High Impact Area: Anti-hypertensive prescribing

19,000,000

19,500,000

20,000,000

20,500,000

21,000,000

21,500,000

22,000,000

22,500,000

23,000,000

2009/2010 2010/2011 2011/2012 2012/2013

Anti-hypertensive Prescribing (ADQs per year) 2009-2013

In 3 years anti-

hypertensive

prescribing

increased by

2318074 ADQs.

Equivalent to a

minimum of 6350

additional patients

being commenced

on anti-hypertensive

medications

Smoking Prevalence

Fall in CVD Admissions

Closing of the gap in under 75 years CVD Mortality rate

Modelling the impact of the interventions

Greenwich LE (pre programme)

------ Trend for Greenwich LE

------ Increased LE due to better detection & management

…… Increased LE due to 3% Smoking Reduction

England LE

------- England Trend

Greenwich Actual