Translating Innovation into Practice: The Cardiology Unmet Needs Project

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Translating Innovation into PracticeThe
Cardiology Unmet Needs Project
Professor Stuart Pringle and Alison
Hume Co-Clinical Leads for the Cardiology Unmet
Needs Project
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Is there evidence of greater need in deprived
communities?

• Yes
• What impact does this have on health status
  and outcome?
• Poorer outcomes
• Higher morbidity
• Reduced survival.

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Inequality (based on 2001 ISD data)
(Average of deprived intervention group compared
to average of affluent control group)
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Aim of the project

• To improve access to cardiology
• To deliver services in deprived communities

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Modelling and re-modelling of clinical activity

• Delivery of Specialist Cardiology Clinic
  (including investigation) in a community venue or
  the clinical mobile unit
• Identification of potential patients from
  opportunistic cardiology assessment at local
  events (e.g. local gala days, bingo, shopping
  centres, the mosque)

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Deprived Communities
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Example of venuesThe Community Heart Clinic
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The Clinical Mobile Unit
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Cardiology clinic in Mark Henderson Centre
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Local Gala days
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Engaging with Ethnic Minority Groups
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Radio Ramadhan 107.5
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Lochee Baptist Church
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Results

• A total of 1781 people have engaged with clinical
  project activity
• 1632 have self presented for an opportunistic
  cardiology assessment (Specialist nurse led)
• 161 have had a specialist clinical consultation
  (Cardiologist led)
• 91 people have had a heart failure clinical
  review
• 17 people have had a heart failure telephone
  clinical review
• 10 of the above are of South Asian ethnicity

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Success of engagement with people living in
the deprived communities

• Areas with the highest deprivation in Tayside
  have been targeted for clinical activity
• By delivering services in the deprived areas the
  majority of people who have engaged are from the
  poorest areas of Tayside
• By taking clinical services to places of worship,
  engagement with the ethnic groups has been
  particularly successful

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Breakdown by deprivation category
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Gender
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The Specialist Cardiology Clinic

• 161 people have had a clinical consultation
• 73 of these had a diagnosis of CHD
• 82 had no known CHD but described significant
  symptoms
• 6 people believed they had CHD but this diagnosis
  was not confirmed following specialist
  consultation

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Investigations as a result of specialist
cardiology consultation
Some people included in these figures are
awaiting further tests and investigation
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Medication management following specialist
cardiology consultation

• Of the 161 people who were seen by the
  cardiologist, 77 (48) had a recommendation for
  medication management to optimise their treatment
  

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What have we learned so far?

• Feasible
• Acceptable patient and HCP
• Opportunistic assessments are popular
• Clinical Diagnosis
• Interventions may be quite low tech e.g.
  up-titrating or optimising medication
• Engagement / re-engagement
• Valuable
• Cost-effective?
• Educational

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