Keep Well Evidence from the Keep Well programme

Keep Well Evidence from the Keep Well programme in NHS Grampian – 2008 to 2014 Jackie Fleming Keep Well Information Analyst

What is Keep Well? • Inequalities-targeted national programme • In NHSG since 2008…. . in Aberdeen City and Moray (Well North) • Health checks covering • Clinical AND health behaviour AND life circumstances • Anticipatory care • CVD risk screening (ASSIGN) • Referral and signposting

Eligibility for Keep Well • Core group • age 40 -64, and living in deprived areas • Vulnerable groups • South Asian (35 -64) • Black Afro-Caribbean (35 -64) • Gypsy Travellers (18 -64) • Substance misusers (18 -64) • Homeless (18 -64) • Criminal Justice (18 -64)

Eligibility for Keep Well • Core group • age 40 -64, and living in deprived areas • identified using the Scottish Index of Multiple Deprivation (SIMD) • Preliminary work gave GP practices a profile of their Keep Well patients: • More than two thirds had a surgery consultation within the previous 12 -18 months

Where is Keep Well delivered? In 2008/09, via 5 GP practices By 2014, via • 37 GP practices • The Healthy Hoose (Aberdeen) • Community pharmacies • Aberdeen Sports Village • Integrated Services Alcohol & Drug Partnerships -Kessock Clinic (Fraserburgh) -Turning Point Scotland (Peterhead; Elgin) -Timmermarket Clinic (Aberdeen) • Community Hospitals (Leanchoil, Forres; Fraserburgh; Peterhead) • Gypsy Traveller sites • Employment Programmes (Peterhead; Banff) • Aberdeen Health & Care Village • Prisons (HMP Aberdeen; HMP Peterhead); HMP & YOI Grampian • Royal Cornhill Hospital

…where delivered? Increasingly varied Delivery Model GP practice 2008/09 2009/10 2010/11 2011/12 2012/132013/142014/15 213 1018 1460 1352 1453 1600 267 Pharmacy 128 208 105 85 8 Substance Misuse Clinics 35 44 3 Carer Initiative 21 11 13 Income Deprived Initiative 8 8 7 Homeless Initiative 3 7 3 Gypsy/Traveller Event 5 10 0 Prison 0 22 0 Criminal Justice 0 2 1 Healthy Working Lives 6 48 Other 183 3 0 0 TOTAL 213 1018 1771 1560 1633 1795 350

Learning. . . 21, 900 patients eligible 16, 561 invited 6, 032 attended Data from this cohort is held in the Keep Well Business Objects Universe (BOU). The following analyses are based on the BOU.

. . . uptake. . . . 36% of patients who were invited, attended a health check. 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Under 40 40<50 Age group 50<60 60+

. . . invitation. . And the method of invitation is important. . 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Letter only Letter & verbal/phone Invitation method Verbal/phone no letter

Health checks. . . Inequalitiestargeting is effective – majority are from the most deprived quintiles

. . health checks. . .

. . . health checks. . . . • Equal proportion of males and females • 69% White Scottish • 249 carers • 150 patients from the homeless practice • 441 patients from ethnic vulnerable groups

. . . health checks. . . . Employment status

Clinical data 23% had blood pressure greater than 140/90 40% % with BP >140/90 35% 30% 25% 20% 15% 10% 5% 0% Under 40 40<50 Age group 50<60 60+

. . . clinical data. . . Men more likely to have high BP than women (26% vs 19%) And for SIMD 25% % with BP >140/90 by SIMD Quintile 20% 15% 10% 5% 0% 1 - most deprived 2 3 SIMD 2009 National Quintile 4 5 - least deprived

. . clinical data. . 57% had a total cholesterol level >5 70% Total Cholesterol >5 60% 50% 40% 30% 20% 10% 0% Under 40 40<50 Age group 50<60 60+

. . . clinical data. . . Women more likely to have high cholesterol than men (60% vs 53%) And for SIMD % with total Cholesterol >5 80% 70% 60% 50% 40% 30% 20% 10% 0% 1 - most deprived 2 3 4 SIMD 2009 National Quintiles 5 - least deprived

. . . clinical data. . . 72% had a Body Mass Index of 25 or more % with high BMI increases with age Men and women similar 80% 70% 60% 50% 40% 30% 20% 10% 0% % with BMI >=25, by SIMD 1 - most deprived 2 3 SIMD 2009 National Quintile 4 5 - least deprived

. . . clinical data. . . ASSIGN CVD risk score is a key element of Keep Well 15% of patients had high risk – ie 20% or greater chance of a CVD event within the next 10 years

. . . clinical data. . . % of patients with high risk increases with age 60% % with high (>=20%) ASSIGN risk score, by age 50% 40% 30% 20% 10% 0% Under 40 40<50 Age group 50+ 60+

. . . clinical data. . . A greater % of men have high risk (17% vs 12% for women) And for SIMD 18% % with high (>=20%) ASSIGN risk, by SIMD 16% 14% 12% 10% 8% 6% 4% 2% 0% 1 - most deprived 2 3 SIMD 2009 National Quintile 4 5 - least deprived

. . . clinical data. . . National Indicator 4: Number who have had at least one new chronic disease identified within 3 months of their most recent health check Diabetes CHD Hypertension 2012/13 (1307 hc) 14 0 15 2013/14 (1374 hc) 12 0 13

Health behaviour data 38% were smokers Smoking status Smoker 38% Non smoker 38% Ex smoker 24%

. . . health behaviour data. . . 45% % smokers by age 40% 35% 30% 25% 20% 15% 10% 5% 0% Under 40 40<50 Age group 50<60 60+

. . . health behaviour data. . . 30% met current guidance of 30 minutes moderate activity 5 days a week % with activity levels at current guidance 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Under 40 40<50 Age group 50<60 60+

. . . health behaviour data. . . Men were more likely to meet activity guidelines than women (35% vs 25%) And by SIMD

. . . health behaviour data. . . Record of alcohol consumption. . 50% Alcohol Consumption 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Teetotal Trivial drinker Light Moderate Heavy Very heavy Ex-heavy drinker drinker Under 40 40<50 50<60 60+ Ex-very heavy drinker

. . . referrals. . . • Formal referrals resulting from health checks are very low • Only 1 -2% of patients at health checks are recorded as being referred to other services • These findings are consistent with those from other Health Board areas

. . . advice. . . However, advice is more commonly recorded, eg • 67% of smokers given smoking cessation advice • % of all health checked patients who have been given on advice : • Alcohol 9% • Activity 21% • Diet 42%

Review patients ‘Kate Wells’ had a health check in 2008 and a review health check in 2013 White Scottish Aged 46 Lives in George St area Working Received low income benefit in ‘ 08 Still enjoys moderate exercise Continues to be a light drinker Smoker

Review patients ‘Keith Weller’ had a health check in 2008 and a review health check in 2013 White Scottish Aged 47 Lives in Northfield Working Received sickness/invalidity benefit in ‘ 08 Enjoyed light exercise in ‘ 08, but now moderate Continues to be a light drinker Ex-smoker Keith BMI BP Cholesterol ASSIGN Score '08 '13 37. 6 34 150/100 130/82 4. 5 3. 8 8 7

Review patients ‘Keith Weller’ had a health check in 2008 and a review health check in 2013 There was no evidence – at either health check – that Keith had been referred, or even been given advice However, subsequent to his review health check, some advice WAS recorded: Activity advice – ‘walks dogs, plays badminton and swims weekly as well’ Diet advice – ‘diet seems quite healthy says biscuits downfall but now changed to crackers and attending Healthy Helpings at Woodend wife likes to cook processed meals, discussed fresh cooked meals says will start cooking fresh meals himself’

Key Findings • Before Keep Well. . two thirds had visited GP practice within previous 12 -18 months • At invitation. . uptake is 36% - however, twice as successful if invitation is in person or by phone • Inequalities-targeted programme reaches target • At health checks. . . the majority • White Scottish, employed • High BMI • High cholesterol • Ex or non-smokers • Do not meet activity guidelines • Referrals are minimal. Advice is more likely