Addressing the needs of hard to reach patients

Addressing the needs of ‘hard to reach’ patients in complying with a phase III cardiac rehabilitation programme Anne Welsh Head of Clinic Action Heart, Dudley BACR Annual Conference 7 th October 2010

Health Inequalities – Local • NHS Heart Improvement National Project – Elderly – Female – Black & minority ethnic – Deprivation – Employment – Travel/Geography – Identify barriers

Health Inequalities – Local • Patient and staff discussions/consultation (Patient Involvement) • • Learning Difficulties Sensory/Physical Impairment ‘Shy’/lacking confidence Language Barriers • Hard to Reach/Hard to Keep

Action Heart Phase III programme • 3 ‘one to one’ sessions • ‘Hard to Keep’ time? • Limited resources

Buddy System “Former patients are trained to provide continued seamless support and surveillance for those individuals requiring further assistance in settling into the Action Heart Phase III programme”

Buddy System Requirements • Ex Action Heart cardiac patient • Desire to help other cardiac patients • Empathetic approach/listening ear • Physical ability to demonstrate use of equipment/warm up etc. • Two hour commitment per week

Buddy System Training (25 hours) – Listening Skills Course – Use of equipment, demonstration methods – Theory/Principles of exercise, understanding exercise programmes – Basic understanding of cardiac conditions/signs and symptoms

Buddy System • Further training – Attendance at Action Heart Education Programme – Cardiac misconceptions – Manual handling – Optional: basic cardiopulmonary resuscitation Further shadowing in clinic by staff until proficient and confident

Buddy System What the role is not! Setting boundaries • A replacement for staff • A counselling opportunity • Medical consultation

Buddy System Eight volunteers (choice of day/time of attendance) • 6 men 2 women 2 retired nurses, 2 retired teachers, 1 retired local government officer, 1 schools inspector, 1 retired school caretaker, 1 bus driver

Buddy System Mrs P, severe anxiety, lacking in confidence, reclusive since heart condition Mr R, partially sighted, never accessed a gym Mrs B, speaks little English, unable to read or write Mr K, understanding/memory/retention issues following stroke, left sided weakness

Buddy System • Patient Survey “The staff are fantastic but the buddies have more time to help me. I would not have continued if the buddies had not been there to support me. ” “ the buddies are so helpful, kind, wonderful and provide excellent advice”

Buddy System • Buddies have flourished – expert listeners, – encouragers, – friends, – information givers, – thriving role models – excellent staff/patient interface

What the Buddies say “I enjoy all aspects of the role… meeting, supporting, getting to know interesting people. Seeing patients improve is all very satisfying”

Outcomes ü ü ü ü Completed 18 months 155 ‘needy’ patients supported 27 hours/week of Buddy cover Positive satisfaction survey Reduced early drop out rate? Enhanced patient/staff links Ready to recruit/train new Buddies

Summary • • Innovative and effective intervention Cost effective Enhances patient/staff interface Captures patient expertise Increased referrals A Win-Win situation! Is this a model for using patient experience in the NHS?

• Thanks to our Buddies to our Patient Involvement groups to the BACR …………………. . and to you for listening • Any questions