Date post: | 09-Jun-2015 |
Category: |
Health & Medicine |
Upload: | virtual-angina-at-liverpool-hope-university |
View: | 1,888 times |
Download: | 4 times |
Overview patient-centred angina services
Professor Mike Chester, Director of the National Refractory
Angina Centre
Person-centred service delivery
“NRAC’s involvement of patients and carers at every stage of the development of their care is something from which the rest of the NHS could learn”
–Jan 2003 Health Commission report
Specialist clinic TWO - THREE hours
Diagnosis: involves patient & carers
»Includes how the angina prevents them
getting what they want
- Agree realistic objectives/compromises
- Explain ‘angina’ and correct misconceptions
- Work out a plan
Professionally prepared ‘homework’ and classes
Results
Angina and Quality of Life after one year of patient-centred care
Improvement p
Angina stability 33% .03
Angina frequency 30% .02
QoL 35% .001
(Moore R et al . Eur J Pain. 2005 Jun;9(3):305-10)
Followed 271 patients for a year before and after coming to NRAC
We counted every hospital admission each month and
averaged the monthly admission days
Moore RK et al., J Pain Symptom Manage. 2007 Mar;33(3):310-316
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271enrolment
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271enrolment
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271enrolment
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271enrolment
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271enrolment
Month 0 Month 10
Monthly Days In Hospital before and after enrolment in NRAC
0
.5
1
1.5
2
2.5
Days in hospital per month
n=271
≈70% Savings
enrolment
Month 0 Month 10
Other patient-centred angina clinics
Chesterfield
Dr Alan Cohen FRCGP, National Primary Care Advisor
Chesterfield
Dr Alan Cohen FRCGP, National Primary Care Advisor
“…based on the ground-breaking work at the National Refractory Angina Centre...”
Chesterfield Results
25 patients -2 groups
Dr Alan Cohen FRCGPNational Primary Care Advisor
All improved with programme 6 x stent procedures avoided 3 x bypasses avoided 1 Angiogram avoided Several admissions avoided
Total Savings
• £43,888 in avoided procedures
• £40,221 saved on hospital activity
• Total saving = £84,109 in 25 patients
Dr Alan Cohen FRCGPNational Primary Care Advisor
Net savings
• 25 Patients
• Overall saving =£31,859
(£84,109 savings minus £52,250 costs)
• £1,274 net saving per patient
Dr Alan Cohen FRCGPNational Primary Care Advisor
Wirral clinic first twenty patients’
experiences
• Corrected misconceptions
• Reduced anxiety
• Encouraged health promoting
behaviours
All patients wished they had
come sooner and
all would recommend the
service to all angina patients
Comments/Improvements: Wirral
• “Fantastic”• “Why did we have to wait so long?”• “The atmosphere was great”• “Everyone listens and explains”• “More of the same for other
patients”• “Nothing to add-Perfect! Thank
you”
Chesterfield
Dr Alan Cohen FRCGP, National Primary Care Advisor
Chesterfield
Dr Alan Cohen FRCGP, National Primary Care Advisor
What patients say
Chesterfield
Dr Alan Cohen FRCGP, National Primary Care Advisor
Patient-centred angina care
Summary
• improves quality of lifeimproves quality of life11
• reduces angina frequency and reduces angina frequency and severityseverity11
• improves functionimproves function22
• reduces hospital admissionsreduces hospital admissions33
• reduces incidence of MIreduces incidence of MI33
1. Moore R et al., Eur J Pain. 2005 Jun;9(3):305-10) 2. Moore R et al., J Pain & Symptom Management;33(3):310-316 3. Furze J et al., Psychosomatic Res 2005 59: 323-29
reduces demand for palliative cardiac procedures (bypass and stents)1,2,3
1. Eur Heart J 1997;18:394-4132. Lewin et al., British Journal of Cardiology 1995; 2(8):
221-2263. Ornish D. Am J Cardiol. 1998 Nov 26;82(10B):72T-76T.
Educated patients
and carers love the
patient-centred
experience
www.angina.org
Thanks for taking the time