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Healthy ActiveRehabilitationProgrammeHARPDr Janet McKayNHS Ayrshire and Arran
Healthcare in Scotland:The current situation Health Boards and Integrated Healthand social care partnerships Realistic medicine National clinical strategy Integrated Care Fund Multi-Morbidity Action plan
A growing problem The majority of over-65s have 2 or moreconditions, and the majority of over-75shave 3 or more conditions More people have 2 or more conditions thanonly have 1 There are more people with multi-morbidityaged 65 than aged 65 (MM is morecommon in older people, but there aremany more middle aged
Multi-Morbidity in Scotland )
Emergency and potentiallypreventable admissions600Annual admission rate per 1000 patients500479Potentially preventable admissionOther emergency 645131020305191421234344756No of conditions78910
Objectives of MM actionplan Make every health and care contact an enabling experience and anopportunity to improve health and wellbeing. Support staff to learn from each other so that specialist staff have bettergeneral skills, and staff in community teams develop extended roles. Managed Clinical Networks work together to develop care and supportpathways and guidelines that make sense for people who have multipleconditions. This will help individuals and staff to make the right decisions,and will ensure people with multiple conditions have the right care,support and rehabilitation, including support to remain in work. Identify people with multiple conditions so that they can access the rightlevel and type of care and support as their needs change. This shouldinclude coordinated health and care services, along with support frompeers, third sector and use of technology
Designing a Multi-morbidityservice
Evidence Base Some small studies of mixed groups Strong evidence for Cardiac and pulmonary Some evidence for Cancer, Stroke and Falls No evidence could be found of a programme suitable for all.
Project brief Three Health and Social care partnershipsFunding 168,000 for Health (plus LA funding)Health and well being programme based on CR/PROne of CHD, Cancer, Stroke, Falls, RespiratoryPlus at least one other condition360 places a year6 classes and 6 clinics across AyrshireDifferent tests of change across the partnerships
Partners Local leisureVoluntary sectorMCN’sHSCPIndividuals with MMMulti-Disciplinary Rehabilitation teamsKeep well
What is HARP Multi morbidity will provide a multidisciplinary assessment from a nurseand a physiotherapist who specialise in supporting lifestyle change andpromoting self- management. They also have the skills to identifyappropriate red flags that would mean further medical advice may benecessary. The patient will then be offered a menu of services which couldinclude Class based exercises Home based exercises Dietary advice / Weigh to Go Self management advice Moving on Together Smoking cessation Psychological support
OutcomesThe expected outcomes for the project are: Participants feel able to make positive personal decisions about theirhealth and well being and receive the support they need to achieve theiraims. Participants live as independently as possible and play an active role intheir community Participants are engaged in the design and delivery of the genericrehabilitation model and it is tailored to local need utilising the skills andexpertise of volunteers and building community assets. Participants benefit from improved lifestyles, health and quality of life. Staff engaged in caring for individuals with multi-morbidity, learn fromeach other and pathways and guidelines will be developed that makesense for people who have multiple conditions.
Tiers of Rehabilitation
Workstreams Training: Volunteer development: Service development: Evaluation
Training: Formal lecture programme on all conditionsShadowing of different specialitiesSharing of practiceAdditional BACPR training for leisureHistory taking and clinical assessment
Volunteer development Volunteers involved in programmeDevelopment of job profile for volunteer helperThird sector engagedActivity buddies being trained
Service development: Based on Cardiac Rehabilitation standardsDevelopment of TiersReferral process and paperworkStaffing in place6 additional classesClasses started end of Nov400 referrals by 1/10/16
Tiers for referrers
Evaluation Three stage approach Strategic outcomes Numbers assessed Interventions carried out Impact on organisation Individual outcomes Qualitative outcomes
Age -6970-90total
Referral SourcetotalConsultantOther AHPSpecialist nurseGPPractice nurse
Referral s
Strategic outcomes Numbers referred 334 Numbers assessed 261 Interventions carried out Transferred tier 7%HARP 52%Part programme 13%UTA 6%FTA 22% Impact on organisation
Individual outcomes(provisional) Physical activity- Increased from 30% to 64% at or nearguidelines Waist went from 22% at guidelines to 44% at guidelines ormade improvements BP went from 61% at target to 85% at or improved to target Visual Analogue scales all improved from 16-75%, all areas Health Thermometer improved by 18%
Patient StoryMr D, aged 60 hasangina and diabetesReferred for HARPAt assessment Mr D wasclinically obese and hadabnormal blood sugar andcholesterol levelsHis mood was lowMr D’s wife alsohas now beenreferred to HARP.She asked to gowhen she saw theimprovements inher husband.3MonthsMr D’s general health hasimproved.Blood sugar is stable.Blood pressure andcholesterol are withinnormal limitsHe is able to exercise moreand self manage hisconditionAchieved target weightloss of 10% 2 stone2lb.Volunteered as activitybuddyCommenced the HARPprogramme.accessed weigh to go,exercise programme andmoving on togetherTaking part incommunity activitiesAchieved target weightloss of 5% 1 stone 1lb.6 Months
Patient Anecdotal FeedbackI wondered if itwas right for me,but having triedit, it was right forme.I have spent a yearmixing with peoplewith cancer, butmixing with othersis so usefulI go homeknackered butim so glad Icame
Staff Anecdotal FeedbackPatients aresaying that theprogramme isworking for themand we need tocontinue it.My patient wasdancing down thecorridor afterachieving their 5%weight lossDoing thismeans I ammorecomfortablewhen I talk topatients incardiac rehababout theirotherconditions
Applying Evidence to PracticeKey Messages: Multi-morbidity isone of the largest challenges we face Cardiac Rehabilitation programmes face increasing numbersof patients with multiple conditions There is little evidence for generic rehabilitation Exploratory work inNHS Ayrshire and Arran suggests theremay be benefit to developing this concept further#bacpr2016
Commenced the HARP programme. accessed weigh to go, exercise programme and moving on together Mr D, aged 60 has angina and diabetes At assessment Mr D was clinically obese and had abnormal blood sugar and cholesterol levels His mood was low Referred for HARP 3 th s Taking part in community activities Achieved target weight loss of 5% 1 stone 1lb.
