NRAC

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Background to the National Refractory Angina's patient-centred care model see www.angina.org

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NRAC

  1. 1. The National Refractory Angina Centre Royal Liverpool and Broadgreen University Hospital, Liverpool, UK www.angina.org Professor Mike Chester, Director
  2. 2. The National Refractory Angina Centre Royal Liverpool and Broadgreen University Hospital, Liverpool, UK www.angina.org “Cardiology’s best kept secret” Professor Mike Chester, Director
  3. 3. National Refractory Angina Centre (NRAC) Established 1996
  4. 4. Post code L14 3PE Western end of the M62
  5. 5. •The UK‟s first patient-centred angina clinic
  6. 6. National Awards • National Nye Bevan award 2000 • National NHS Hospital Doctor award 2002 • Health Service Journal King‟s Fund Safety ward highly commended 2003 • UK Customer Experience award 2009
  7. 7. Ann Keen Health Minister, HANSARD 15 Oct 2008 “The ongoing development of the NRAC as a national and international centre of excellence for the treatment and management of refractory angina, …
  8. 8. means that we have not only the best possible service to which people in this country can be referred for that condition,……
  9. 9. ….. but a blueprint for the development of other such services elsewhere.”
  10. 10. And the revolutionary concept was……
  11. 11. Ask patients what they want..
  12. 12. Ask patients what they want.. …then explain the options
  13. 13. “Making consent patient-centred” John Bridson, Clare Hammond, Austin Leach & Michael R Chester BMJ 2003;327;1159-1161 doi:10.1136/bmj.327.7424.1159
  14. 14. Commission for Health Improvement report Jan 2003
  15. 15. “NRAC‟s involvement of patients and carers at every stage of the development of their care……
  16. 16. “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 ”
  17. 17. Patient empowerment & patient engagement Depend on Patient education
  18. 18. Most patients don’t really understand what is wrong with them
  19. 19. Most blame themselves for being ignorant
  20. 20. Few would think of criticizing their doctor for being poor teachers
  21. 21. What makes a good doctor?
  22. 22. What makes a good doctor? “Always finds time to listen and............ the really good ones explain”
  23. 23. The problem
  24. 24. “Because the presentation of ischaemic heart disease is often dramatic……
  25. 25. “Because the presentation of ischaemic heart disease is often dramatic…… ..and because of impressive recent technological advances………
  26. 26. ….. healthcare providers tend to focus on diagnostic and therapeutic interventions…..
  27. 27. ……. often overlooking critically important aspects of high- quality care.
  28. 28. ……Chief among these neglected areas is the education of patients.”
  29. 29. Joint American Cardiology associations‟ Stable Angina guidelines http://www.americanheart.org/presenter.jhtml?identifi er=3004542 ……Chief among these neglected areas is the education of patients.”
  30. 30. Educating patients…..
  31. 31. • improves quality of life1 • reduces angina frequency and severity1 • improves function2 • reduces hospital admissions3 • reduces incidence of MI3 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
  32. 32. •reduces demand for palliative cardiac procedures (bypass and stents) 1,2,3 1. EurHeart J 1997;18:394-413 2. Lewinet al. British Journal of Cardiology 1995; 2(8): 221-226 3. OrnishD. Am J Cardiol. 1998 Nov 26;82(10B):72T-76T.
  33. 33. Jon Develing Specialist Cardiac Commissioner in 2002
  34. 34. “I believe that the patient centred treatment approach being offered presents a real alternative to other forms of treatment…
  35. 35. … including revascularisation, catheterisation and other invasive procedures including the high cost treatments such as DES (drug eluting stents)”
  36. 36. “The economic savings and impact on activity and waiting list targets have the potential for efficiencies and modernisation”
  37. 37. Bob Ricketts (Head of Access Policy Development and Capacity Planning at the DoH) to Duncan Selbie, (Director General of Commissioning DoH) 2006
  38. 38. “I heard Mike [Chester] present at Harrogate and have also discussed with Ian Rutter and others the underpinning evidence. This is deeply impressive work which could generate substantial benefits in terms of improved patient care and value for money.”
  39. 39. “I heard Mike [Chester] present at Harrogate and have also discussed with Ian Rutter and others the underpinning evidence. This is deeply impressive work which could generate substantial benefits in terms of improved patient care and value for money.”
  40. 40. Judge of Judges UK Customer Experience Award 2009 „NRAC is the NHS experience that the patient has been waiting for”
  41. 41. But… only if
  42. 42. drugs have failed and operations are technically unfeasible
  43. 43. you would prefer to avoid an operation unless it is „life or death‟
  44. 44. Most angina patientswrongly believe that angioplasty and stent procedures prevent heart attacks
  45. 45. The properly educated know better
  46. 46. Dr Martin Thomas President of the British Association of Interventional Cardiologist’s Aug 2007.
  47. 47. “It has never been the interventionist’s claim that PCI impacts on mortality” Medical version
  48. 48. “We never never said that unblocking arteries with a balloon makes patients live longer” Patient version
  49. 49. So why do so many patients think it does?
  50. 50. Joint American Cardiology associations‟ Stable Angina guidelines http://www.americanheart.org/presenter.jhtml?identifi er=3004542 ……Chief among these neglected areas is the education of patients.”
  51. 51. Over 99% of NRAC patients agree with the authorities and think patients should be properly educated before operations
  52. 52. Thanks for taking the time www.angina.org

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