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NUDGE Master Class presentation

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Plenary presentation from Dr Jack Bedeman and case study presentations

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NUDGE Master Class presentation

  1. 1. ‘To nudge, or not to nudge’ Understanding how behavioural insights can deliver improved healthcare Wednesday, 13 January 2016, 10.00am – 4.00pm Radisson BLU Hotel Durham, Frankland Lane, Durham, DH1 5TA
  2. 2. Objectives: • Enable delegates to gain an in depth understanding of the ‘Nudge’ concept and behavioural insights methodology • Ensure participants are able to apply nudge/ behavioural insights in a clinical setting within their organisations • Promote participant networking to exchange and share their learning and collaborate on potential nudge plans across the North East and North Cumbria • Enable participants to access a suite of resources and materials to support them in developing these plans and putting them in to practice. • Encourage delegates to take their learning back in to their organisations to share and put this learning in to practice.
  3. 3. Understanding and changing behaviour: applying behaviour insights to health Dr Jack Bedeman Public Health Registrar Department of Health
  4. 4. Understanding and changing behaviour: applying behaviour insights to health DH Behavioural Insight Team
  5. 5. 5 almost all of us would donate organs after we die  it takes 30 seconds high awareness of the organ donor register
  6. 6. 6 Benefits your health Free of charge if on a low income Advice from GP and the NHS
  7. 7. 7 Conscious, planned, reflective behaviour Subconscious, automatic behaviour
  8. 8. 8
  9. 9. 9 Before we can change behaviour, we must first understand it…
  10. 10. 10 Michie et al (2011) COM-B: A simple model to understand behaviour Capability Opportunity Motivation Attending hospital appointments Behaviour
  11. 11. 11 Michie et al (2011) COM-B: A simple model to understand behaviour Capability Knowledge, skills and abilities to engage in the behaviour Physical Physical ability to get to the hospital Psychological Understanding of why you need to go to the appointment Attending hospital appointments
  12. 12. 12 Michie et al (2011) COM-B: A simple model to understand behaviour Opportunity Attending hospital appointments Outside factors which make the behaviour possible Social Seen as OK to attend during work time Physical Availability of transport to get to the hospital
  13. 13. 13 Michie et al (2011) COM-B: A simple model to understand behaviour Motivation Brain processes which direct our decisions and behaviours Automatic Experiencing symptoms on the day Reflective Concerns about treatment Attending hospital appointments
  14. 14. 14 Task one: understanding and specifying the target behaviour
  15. 15. 15 Defining the behaviour and the objective
  16. 16. 16 Here’s an example of a poorly defined outcome The objective is to reduce pressures on NHS A&E departments. The aim is to concisely state what you are trying to achieve. It’s not clear what reduced pressure means. What sort of reduction? All NHS Emergency Departments? And in all ways? If all (as this implies), we might be better considering starting small to prove the concept before rolling out. ‘Pressure’ could mean lots of things. Better to look at specifics, even if there are lots of them to consider in sequence.
  17. 17. 17 Define the problem you aim to solve The objective is to reduce by 5 per cent attendance at Medway Hospital’s A&E department from patients presenting in non-urgent situations Ideally start with a quantifiable objective, even if modified later. Start thinking early about the size of effect needed for the project to be worthwhile. We usually start behavioural insights projects on a small scale, and then scale up if we are confident that something is working. Try to be as clear as possible about the specific behaviour you want to change i.e. what, by who, and when. Most policy challenges involve more than one ‘behaviour’ – and by a variety of people e.g. patients and staff. It is easiest to consider each separately.
  18. 18. 18 Surprise Hyperbolic Discounting Social Learning Priming Placebo Effect Decoupling Proccrastination Availability Impact Bias Long-Tailed Risk Social Identity / norms Habit Anticipation of Reward Simplification Band Wagon Effect Anchoring Optimism Bias Intertemporal Choice Business Norms Intuition Messenger Planning Fallacy Key Influencers Hindsight Bias Loss Aversion Attention Collapse Identity Salience Status quo bias Hedonic Framing Cognitive Load Gaming Sunk Costs Defaults Regret Choice Bracketing Certainty Bias Altruism Social Proof Mental Accounting Ambiguity Effect Reciprocity Framing Information Avoidance Endowment Effect Inequity Aversion Commitments Representativeness Participatory Effect Teachable moment Cognitive Dissonance Over-Extrapolation Actor-Observer Bias Omission Bias Attribution Error Segregation Effect Behavioural insights / concepts
  19. 19. 19 Capability Opportunity Behaviour Motivation Automatic Motivation
  20. 20. 20 Simplify messages Break the goal down into simple actions Reduce effort Defaults EASY
  21. 21. 21 The revised chart led to much more accurate information (and less errors) 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0% 100.0% Dose entered correctly Prescriber's contact number entered Frequency of medications entered correctly Proportionofmedicationorders Existing chart (n=174) Improved chart (n=163) King et al. (2014) Redesigning the ‘choice architecture’ of hospital prescription charts. Forthcoming.
  22. 22. 22 A surgical safety checklist reduced deaths and complications following surgery by a third. Haynes, A et al: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England J Medicine 2009; 360:491-499
  23. 23. 23 Suicide by paracetamol in England and Wales, 1993-2009 Hawton Keith, Bergen Helen, et al. Long term effect of reduced pack sizes of paracetamol on poisoning deaths and liver transplant activity in England and Wales: interrupted time series analyses BMJ 2013; 346:f403 Legislation reduced the maximum size of the packages to 16 pills (or 32 if sold at a pharmacy) i.e. less convenient to purchase and retain multiple tablets.
  24. 24. 24 Attract attention Lotteries Incentives & Rewards Images & Colour Personalisation ATTRACTIVE
  25. 25. 25
  26. 26. 26
  27. 27. 27 Public promises Make a commitment Social norms Networks SOCIAL
  28. 28. 28 “The great majority (80%) of practices in [NHS Area Team] prescribe fewer antibiotics per head than yours”. Three simple actions… From a trusted authority figure Personally addressed
  29. 29. 29 Old letter ‘nudge’ letter Bonus A, Berry D: Increasing Uptake of the NHS Health Check . Report of research with Medway Council to optimise the invitation letter . 2013. available at www.healthcheck.nhs.uk/document.php?o=588 29 33 0 5 10 15 20 25 30 35 old letter nudge letter Attendance rate % DH – Leading the nation’s health and care
  30. 30. 30 Prompts Make a plan RemindersImmediate costs and benefits TIMELY
  31. 31. 31 DH – Leading the nation’s health and care
  32. 32. 32 Fogarty AW, Sturrock N, Premji K, Prinsloo P. Hospital clinicians’ responsiveness to assay cost feedback: a prospective blinded controlled intervention study. JAMA Intern Med 2013;173:1654–5. DH – Leading the nation’s health and care
  33. 33. 33 Task 2: Applying behavioural insights to policy problems
  34. 34. 34 The ‘Nudge Game’
  35. 35. 35 DH – Leading the nation’s health and care CONTROL INTERVENTION Group is split into two groups by random lot Outcomes are measured for both groups Testing behavioural insights
  36. 36. 36
  37. 37. 37
  38. 38. 38
  39. 39. 39 1. Advice on behavioural insights and how to apply these to your policy area 2. Support designing BI interventions DH BI team 3. Support designing and running BI experiments and trials
  40. 40. 40 Behavioural insights literature Excellent summary text Understanding full range of behaviours Guide for policy- makers COM-B: http://www.implementationscience.com/content/pdf/1748-5908-6-42.pdf EAST framework: http://www.behaviouralinsights.co.uk/sites/default/files/BIT%20Publication%20EAST_FA_WEB.pdf
  41. 41. 41 How to infuence public behaviour Drink Aware web site NHS Organ Donation web site
  42. 42. Case Study: Quantifying and modifying patient attendance in a primary care setting. Dr Roger Dykins, Corbridge Health Centre
  43. 43. HPCA KTP Overview and outcomes 18th November 2015 KTP Team: Alexander Tang Northumbria University & Corbridge Medical Group Prof Glenda Cook Northumbria University Julie Johnston Corbridge Medical Group Dr Robin Hudson Corbridge Medical Group Dr Roger Dykins Corbridge Medical Group Dr Akhtar Ali Northumbria University Dr Emma Barron Northumbria University Hazel Juggins Northumbria University John Clayton Innovate UK
  44. 44. KTP Aim & Objectives • Data warehousing and data mining of practice clinical information systems • Analysing current service activity • Designing a stratification system for the management of chronic disease • Redesigning systems and professional practice for the management of chronic conditions in the practice population • Develop a training strategy for effective use of the proposed system • Develop and agree the practice service model for chronic disease management • Pilot model and evaluation Service development grounded in analysis of GP practice data 30th April 2012 Clinical topics and priorities Organisation and business challenges
  45. 45. 0 50 100 150 200 250 300 NumberofPatients Age Group of Patients on 31-Aug-2014 CMG Registered Patients Demographics (2013) Male Female Male Trendline Female Trendline 0 50 100 150 200 250 300 350 NumberofPatients Age Group of Patients on Date of Death CMG Deceased Patients Demographics Male Female Male Trendline Female Trendline
  46. 46. 0 10000 20000 30000NumberofConsultations Age Group of Patients on Date of Consultation CMG Activity Type Consultations for Current Patients (2013) Home Visit Telephone GP Surgery 0 4000 8000 12000 16000 NumberofConsultations Age Group of Patients on Date of Consultation CMG Activity Type Consultations for Deceased Patients (2013) Telephone Home Visit GP Surgery
  47. 47. 0 5000 10000 15000 20000 25000 NumberofConsultations Age Group of Patients on Date of Consultation CMG Clinician Type Consultations for Current Patients (2013) Healthcare Assistant Nurse General Medical Practitioner
  48. 48. 0 5000 10000 15000 20000 25000 30000 35000 40000 45000 2009 2010 2011 2012 2013 Consultations Year CMG Activity Types Consultation between 2009 - 2013 Total Cons GP/ Surgery GP/ Telephone GP/ Home Visit Nurse/ Surgery HCA/ Surgery GP/Surgery Nurse/Surgery Total GP/Home GP/Tele HCA/Surgery
  49. 49. Key Messages from the Analysis of Practice Activity • Increase in total number of consultations per year over 2009 - 2013 • Steady increase in the number of patients having consultations each year (4.4% increase) • 1065 (16%) patients with no consultations in 2013 • 41% registered patients on a QOF register – 61% of the overall 2013 consultation workload – 53% of GP surgery consultations, and 92% of GP home visits in 2013 • Patients with high consultation activity is not only accounted for by those on the QOF registers and 80+ population • 20 patients not on any QOF, HRPP or Housebound register yet they are in the Top 200 Consultees between 2009 – 2013 – 2.1% of the overall 2013 consultation workload
  50. 50. cluster5 cluster1 cluster9 CMG Workload Clusters Clusters 1, 5 and 9 include 377 patients (6% of the registered practice population) accounting for 24% of the total consultations in 2013. Numberofconsultations(2013) Age
  51. 51. 6.6 32.7 5.4 9.6 7.2 33.6 6.3 3.1 10.3 20.4 0 5 10 15 20 25 30 35 cluster0 cluster1 cluster2 cluster3 cluster4 cluster5 cluster6 cluster7 cluster8 cluster9 NumberofConsultationsoverNumberofPatientsseen Cluster Name Average number of Consultations per Patient in each Cluster (2013) Clustering Analysis
  52. 52. Practice A Workload Clusters Clusters 0, 2 and 7 include 393 patients (7% of the registered practice population) accounting for 28% of the total consultations in 2013.
  53. 53. Practice B Workload Clusters Clusters 3, 5 and 7 include 314 patients (4% of the registered practice population) accounting for 19% of the total consultations in 2013.
  54. 54. 0 5000 10000 15000 20000 25000 GP/Surgery GP/Telephone GP/Home Visit Nurse/Surgery Nurse/Telephone HCA/Surgery Number of Consultations ActivityType Activity Type Consultation Comparison between HPCA Practices (2013) Corbridge Medical Group Practice A Practice B • On average High Users account for 6% of population and 22% of the overall workload Practice Registered Patients CMG 6592 A 5650 B 7131
  55. 55. 55 Extremely High Users 20+ cons Very High Users 15 - 20 cons Moderate High Users 10 - 14 cons 341 patients 4986 GP surgery and home visit consultations 43.1% workload in 2013 39 patients 1108 cons 9.6% of workload in 2013 122 patients 1388 cons 12% of workload in 2013 219 patients 2490 cons 21.5% of workload in 2013 Traffic Light Thresholds
  56. 56. High Users Consultation Alert – EMIS Web • Limitations with EMIS Web Protocols & Concepts to identify difference in consultation types (surgery, telephone, home, admin etc.) • Feasibility to alert user based on certain read codes only • How does this or could change consultations with patients? • Across HPCA: Could different approaches/services be offered to high user patients?
  57. 57. High user alert – GP views/actions • Surprise when a patient who they did not expect to be a high user comes into the surgery • Patients often see different GP’s and the alert has supported identification of these patients • For some patients the GPs are arranging telephone reviews in order to move workload from face to face appointments into telephone work • GP suggesting review periods to patients • GPs have decided to take a closer look at their top 10 surgery consultees and top 10 home visit consultees to investigate if there are interventions that may have an impact on consultations whilst enhancing quality care
  58. 58. Why do patients seek consultations Analysis of presenting problem titles GP Surgery & Home Visit consultations (Aug 2014 – July 2015) Common Presenting Problem Title Patients Occurrence Ratio Musculoskeletal problems 183 592 3.23 Acute Respiratory 158 370 2.34 Digestive System 155 366 2.36 Dermatology 159 342 2.15 Depression and Anxiety 92 300 3.26 Ear / Nose / Throat 103 190 1.84 Cardiovascular Disease and Stroke 62 188 3.03 Neurological and Nervous System 85 171 2.01 Symptoms / signs and ill-defined conditions 75 132 1.76 Chronic Obstructive Respiratory Disease 36 132 3.67 Urinary Tract Infection - Suspected and Actual 66 108 1.64 Genitourinary 59 104 1.76 Women's Health / Gynaecological / Pregnancy 51 96 1.88 Hypertension 41 88 2.15 Infectious and parasitic diseases 51 87 1.71 Neoplasms 32 86 2.69 Operations / procedures / sites 51 83 1.63 Circulatory system diseases 40 82 2.05 Mental disorders 28 71 2.54 Eye and Sight problems 50 66 1.32 Respiratory system diseases 31 65 2.1 Medication Review and Advice 43 55 1.28 Alcohol 3 25 8.33 10+ Consultations
  59. 59. Can future consultation activity be forecasted?
  60. 60. Risk Stratification: GP Consultations High Risk Patient Pathway Depression Atrial Fibrillation Group 1 (AIC 746) 10 ** Depression 7 Stroke/TIA 5 PAD 5 CHD 3 Heart Failure 3 Female 3 Housebound -3 Rheumatoid Arth. -5 No No Y e s Y e s Group 2 (AIC 1707) 5 ** Diabetes 6 CKD 4 Female 1 Meds*** 0 Group 3 (AIC 360) 6 ** Dementia 13 Atrial Fibrillation 8 PAD 7 Asthma 6 Age 70-80 yrs.* 5 Group 4 (AIC 938) 5 ** Housebound 6 CKD 3 Stroke/TIA 3 Group 5 (AIC 9138) 5 ** Palliative Care 4 Rheumatoid Arth. 2 Dementia 1 Female 1 Stroke/TIA 1 PAD 1 COPD 1 Meds*** 0 Age 60-70 yrs.* -1 Age 50-60 yrs.* -1 Below 50 yrs.* -1109 275 56 137 160 3 *Age coefficients relative to 50-60 age group; **Numbers roughly equate to extra number of visits and title number in each table is roughly baseline number of visits; *** Meds is per medication; Consultations are GP Surgery and Home Visits, totalling 11579 in 2013. Hypertension Y e s Patients Consultation s 5% (616) 11% (1218) 3% (392) 7% (868) 73% (8485) Key:
  61. 61. Presentation suggestive of UTI in adult Consider face to face assessment if:  Systemically unwell eg fever  Frail / elderly  Sx of upper urinary tract infection eg flank pain  Recurrent UTI ?clinical examination - ?Need for further investigation If >1+ haematuria repeat urine dip 2w post treatment (refer if ongoing sterile microscopic haematuria on 3 x urine dips over 1 month period) MSU should be sent when possible Treatment of UTI : 3 days of trimethoprim or nitrofurantoin [If GFR >45] - (guided by previous MSU sensitivities) - for Simple UTI 7 days if:  Upper UTI (use coamoxiclav)  Complicated (constipation associated, structurally abnormal urinary tract, urinary retention)  Male  Catheter UTI  Pregnancy (use cephalexin) Clinical assessment – face to face or telephone Urinalysis • HCA/Nurse dips urine and creates externally entered consultation to record result. • Pass slip to doctor with result • Retain sample for MSU • Reception to ascertain from patient whether suspected UTI (not cystitis) • Ask patient to bring urine sample • pass to HCA/nurse (or duty doctor if not available) using protocol with slip Notes:  Consider self management plan if recurrent  Consider further investigation in repeat sterile MSU eg ?overactive bladder ?malignancy  Consider sexually transmitted pathogens in patients with sterile MSU eg chlamydia / gonorrhea
  62. 62. One-Stop-Shop Pilot Patient Disease review Medication review/med issue Current problems/issues Managing acute illness Skill sharing and planning more powerful with 2 clinicians in room Patient felt cared for and able to talk about things that were important to them but not normally discussed Joint consulting very helpful Summary document about patient is useful. Patient: A reminder of the care plan and life plan. Care Plan in some cases has also had a real impact Questionnaire may have had a influence on how patients feel about their condition and/or state of health
  63. 63. ‘GPs are amazed at the impact the One Stop Shop chronic disease review clinic seems to have had on the timelines – genuine changes seem to have been achieved even though we are uncertain what has made the difference.’
  64. 64. Overall Key Issues • High service users are not necessarily those with multimorbidity and older • There are high services users not included on any registers • GP consultation thresholds of 10+; 15+;21+ can be used to identify clusters of intense service users • Clinical predictors can be used to identify risk for increased consultation levels • Increasing consultation levels is not sustainable within existing service delivery models • Transformation of service delivery could involve development of workforce roles; redesign of clinical pathways for common presenting problems (UTI); consideration of the workforce skill mix or economies of scale achieved across practices for intense service users • Practice data can be used to inform transformation of service delivery
  65. 65. How “Nudge” is Being Used in the Telehealth Programme North East and Cumbria Paul Marriott Independent TECS Consultant (Paul Marriott TECS Ltd) AHSN NENC Telehealth Programme Lead TECS Lead Consultant NHS England Strategic Clinical Networks TECS Clinical Advocate NHS England
  66. 66. South of Tyne & Wear Northumberland Durham The South of Tyne & Wear PCT Telehealth Project ran from May 2011 to March 2013 Population of around 644,000 3 - Foundation Trusts 3 - PCT’s / CCG 3 - Metropolitan Councils Sunderland, Gateshead and South Tyneside The Origins of Telehealth In Tyne & Wear
  67. 67. “The headline findings of Telehealth were mixed. The good news was that mortality of Telehealth patients over the year of the trial was 46% less than the control group. Hospital admissions were 18% lower. To me, these figures should be enough to justify an immediate rollout. I fancy the idea of increasing my chances of staying alive. But it won't happen – because the third big finding of the report was that Telehealth would not save money.” The Guardian 2nd July 2012 Headlines on the Whole System Demonstrator Only 3 Conditions were Included in the Trial
  68. 68. 1st Generation Telehealth
  69. 69. 2nd Generation Telehealth
  70. 70. 3rd and Now 4th Generation Telehealth
  71. 71. Annual Average Cost Per Patient by Generation of Equipment Equipment Type 1st Year Capital Purchase Cost Annual Leasing Cost Annual Maintenance Cost Total 1st Generation Purchased System £2000 £1000 £3000 2nd Generation Leased System £1150 £1150 3rd & 4th Generation Rapid Deployment Leased System £365 £365 SMS Florence System NHS Owned £45 £29 £74
  72. 72. Optimum Health Good Health Average Health Signs of Illness Chronic Illness Irreversible Illness Death WholeLifePerspective Conception Death The Multi Matrix Model Seeks to Cross “The Whole Life Perspective”
  73. 73. NHS Florence SMS Simple Telehealth System SMS Prompts and advice GP Practices Specialist Clinicians Community and Specialist Nursing Public Health And the 3rd Sector Local Authority Control Room and Adult Social Care
  74. 74. Example of Flo Messages A quick reminder that your Blood Glucose Reading is due e.g. “BG 6”. Thanks Flo Your blood glucose reading is fine. Take care Flo Your blood glucose reading is a little high today. Please refer to your management plan and follow the advice provided. Take care Flo Your reading indicates that you might need a change to your treatment. Please ring . . . immediately. Take care Flo
  75. 75. RESEARCH ARTICLE Randomised Trial of Text Messaging on Adherence to Cardiovascular Preventive Treatment (INTERACT Trial) David S. Wald*, Jonathan P. Bestwick, Lewis Raiman, Rebecca Brendell, Nicholas J. Wald Wolfson Institute of Preventive Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, United Kingdom *d.s.wald@qmul.ac.uk Conclusions: In patients taking blood pressure or lipid-lowering treatment for the prevention of cardiovascular disease, text messaging significantly improved medication adherence compared with no text messaging. Trial Registration: Controlled-Trials.com ISRCTN74757601
  76. 76. Condition Clinical Lead  Heart Failure, Angina etc. FT, GP  COPD and Respiratory etc. FT, GP  Hypertension GP  Diabetes FT, GP  Gestational Diabetes FT  Type 1 Kids T1KZ FT, GP and 3rd Sector  Parkinson’s FT  Rapid Discharge FT  Carers Pathway GP, LA & PH and 3rd Sector  Acquired Head Injury and Stroke FT, GP  Primary Care Step Up Step Down GP  Care and Nursing Home GP, LA  Weight Management FT, GP, LA & PH  Smoking Cessation LA & PH  Remote Wound Dressing Monitoring FT  Community Matron Case Load FT  Alcohol Induced Morbidity FT, GP FT = Foundation Trust GP = General Practitioner LA & PH = Local Authority & Public Health Some of the Current Pathways within the North East and Cumbria (there are now over 220) Expand and Widen the Number of Telehealth Pathways and Clinicians
  77. 77. Florence Usage across the NHS in the UK and the DVA in the USA
  78. 78. Patient Outcomes COPD Patient “I am much better now as I am using 02 readings to prompt using oxygen I feel my condition is more controlled now.” COPD Patient “I like the reminder text as I would forget. Prompts me to think about doing my breathing exercises when readings are low. I like the freedom of doing the reading more often.” Heart Patient “Its easy to use and my son helps with the readings. Its great we can now go to family members for example at Christmas and continue to do readings.” Young Diabetic “I Don’t have to come in every week now which is much better I have a busy life and that helps as I have a another child which I needed to get looked after. Costs me £8 on bus to attend each appointment at clinic.” Middle Aged Diabetic “Really happy with the service. It’s a combination of exercise Programme and monitoring my health my control is far better now” Community Nursing Patients Feed Back
  79. 79. Telehealth with a human touch Florence Patient Video
  80. 80. Contact Details Paul Marriott Independent TECS Consultant (Paul Marriott TECS Ltd) AHSN NENC Telehealth Programme Lead TECS Lead Consultant NHS England Strategic Clinical Networks TECS Clinical Advocate NHS England NHS England Northern Senate Waterfront 4, Goldcrest Way Newcastle upon Tyne, NE15 8NY Mob: 07779816519 paul.marriott@nhs.net marriott.p1@sky.com www.england.nhs.uk AHSN North East North Cumbria Biomedical Research Building Campus for Ageing and Vitality Nuns’ Moor Road Newcastle upon Tyne NE4 5PL www.ahsn-nenc.org.uk
  81. 81. A Nudge in the Right Direction for Physical Healthcare within Mental Health and Learning Disability Services Alexia Hardy, Physical Healthcare Project Lead Pauline Smith, Physical Healthcare Project Nurse
  82. 82. People with a SMI die on average 15-20 years sooner than the general population Approximately 40% of these service users are obese, compared to 25% of the general population (The NHS Information Centre 2014). Type 2 diabetes – prevalence 2-3 times higher. People with a SMI are twice as likely to die from heart disease. 61% of people with schizophrenia smoke (33% of general population). (The Abandoned Illness, Schizophrenia Commission 2012) NOW DECREASED TO 20% People with schizophrenia who develop cancer are 3 times more likely to die. Context
  83. 83. Clinical Guidelines  NICE: Guidelines for Schizophrenia (2009 & 2009)  NICE: Smoking cessation in secondary care: acute, maternity and mental health services (November 2013)  NICE: Psychosis & Schizophrenia in Adults (February 2014)  NICE: Physical Health, Obesity, Lipid Modification, Preventing Type 2 Diabetes, Hypertension (Various dates) Government Policy  National Service Framework (DoH 1999) > SMI Registers  No Health without Mental Health (DoH 2012)  NHS Outcomes Framework (DoH 2012)  The Abandoned Illness (Schizophrenia Commission 2012)  National Audit of Schizophrenia (2012)  Cardiovascular Outcome Strategy (2013) The National Agenda
  84. 84. Physical Healthcare Project 2014-16 Business Plan priority to develop standards required for the assessment and monitoring of physical health. Local CQUIN 2014/15 Health promotion for people with psychosis accessing community services focussing on weight management and smoking cessation. GP Engagement Project 2014-17 Aims to improve clinical communication with GPs using standardised electronic referrals and discharge letters. National CQUIN 2014/15 Improving physical healthcare to reduce premature mortality in people with SMI. TEWV Physical Health Agenda Smoke Free Project TEWV aims to go smoke free on 9th March 2016 (National No Smoking Day).
  85. 85. Physical Healthcare Project 2014-16 EWS • Bespoke training offered to services Trust-wide. • Additional support post training. EWS audit across all service areas to monitoring compliance of new procedure and identify where staff may need further support. • EWS Procedure • Diabetes Management Guideline • Cardiovascular Guideline • Staff Engagement Events/Workshops • Staff and Student Induction • Patient workshops • Patient and carer meetings/focus groups Engagement and communication Development of standards Training Audit • Project Newsletter for staff • Project update for patients and carers • Social Media • Page on Trust intranet Diabetes Management • E-learning in line with new guideline. • Pilot of face to face training.
  86. 86. • Involved and engaged staff by asking ‘What does physical healthcare mean to you?’ • Used staff thoughts and ideas to produce project banner to emphasise the whole body in mind. • National ‘nudge’ and interpretation of NICE. • Development of standards in a language suitable for mental health and learning disability settings. • EWS Quick Reference Guide to support recognition and response to the deteriorating patient. • Bespoke EWS training delivered within service areas across the Trust. Staff Nudge
  87. 87. Patient and Carer Nudge Empowerment Thought provoking Increased awareness Informative
  88. 88. Thank you

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