Tackling high blood pressure - PowerPoint Presentation

Slide1

Tackling high blood pressureA case for CCG action

Clinical Commissioning Group (CCG)

slide deck – prepared

18

/12/2015

Background

Public Health England supports

a new programme of work on tackling high blood

pressureAs part of this we are working to support local to develop leadership around high blood pressure. Our resource hub gathers key materials to support service planning and deliverThis slide set is intended to support colleagues working in Clinical Commissioning Groups to make the case for a focus on high blood pressure within their organisationThis slide deck is intended to facilitate a discussion about prioritising prevention, detection and/or management of high blood pressure locally

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Tackling high blood pressure

DELETE BEFORE PRESENTING

Introduction

High blood pressure leads to

costly and disabling conditions

including stroke, heart failure, heart attack, chronic kidney disease and vascular dementiaTackling high blood pressure is therefore a major opportunity for CCGs to reduce premature mortality and save on health and social care spending12 national organisations including Public Health England and NHS England are leading new action on this issueThis presentation sets out key insights and evidence from that work, to assist local teams in discussing how to improve the prevention, detection and management of high blood pressure 3Tackling high blood pressure

Contents

Why tackle high blood

pressure

Impact on health systemNational performanceLocal performanceNew national leadershipHigh blood pressure action plan Prevention Detection

ManagementResource

hub

Healthier Lives Hypertension Atlas

Future

plans

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Tackling high blood pressure

Why tackle high blood pressure

High blood pressure affects

more than

1 in 4 adults in EnglandIt is the one of the leading risk factors for premature death and disabilityPeople from the most deprived areas are 30% more likely than the least-deprived to have high blood pressure Directly addresses NHS Outcomes Framework 1.1 under 75 mortality rate from cardiovascular disease and wider Quality and Outcomes Framework (QOF) and local performance measuresImprovement is achievable:

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Tackling high blood pressure

Adults with high blood pressure diagnosed

and

controlled

England average

37%

England’s Top CCG

(South

West Lincolnshire)

56%

Canada average

66%

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Tackling high blood pressure

Global Burden of Disease:

England results

Impact on health system

7

Tackling high blood pressureHigh blood pressure accounts for approximately 12% of all GP consultationsEstimated £1bn drug costs

for high blood pressure per year

Diseases

caused by high blood pressure cost the NHS over £

2bn

every

year (~£10m per CCG)

stroke £850m

c

oronary

h

eart

d

isease £750m

v

ascular

d

ementia £320m

c

hronic

k

idney

d

isease £200m

A

dditional cost of social care

Positive change in last decade - slightly lower population average blood

pressure (

↓

3mmHg systolic), 2 million people newly identified, 10% more on treatment achieving control), however:Significant variation between CCGs (average BP control 61-94% / average proportion of hypertensives identified 37-66%) between income groups (30% more with hypertension in most-deprived areas versus least)National performance

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Tackling high blood pressure

Local performance

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Tackling high blood pressureNOTE TO PRESENTER: YOU MAY WISH TO INCLUDE LOCAL DATA FROM:Your CCG’s cardiovascular (CVD) intelligence pack, available at http://www.yhpho.org.uk/ncvinintellpacks/Default.aspx  see slides 11-19 on hypertension, which are fully formatted for use

Your CCG’s profile on the healthier lives: hypertension site, available at http://

healthierlives.phe.org.uk/topic/hypertension 

data can be downloaded for all high blood pressure indicators by searching your CCG name, then selecting ‘download data’ via the link at the bottom left

 data can also be viewed in interactive map form, and comparisons made with similar CCGs, more details on how to use this tool on the ‘about the data’ page

CREATE YOUR OWN SLIDE

New national leadership

Since 2014, England’s Blood

Pressure System Leadership

Board (a cross-sector group) has overseen a programme of work improve the prevention, detection and management of high blood pressure, and reduce health inequalitiesPublished in November 2014 Tackling high blood pressure: from evidence into action

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Tackling high blood pressure

High blood pressure action plan

Intended to

support partners

at all levels to focus upon the work that will make the biggest impact in tackling high blood pressureContains advice specifically for NHS commissionersDraws on the best evidence (including new economic analysis) and professional judgment of our group to:Recommend most pressing issues on blood pressure pathway to addressdemonstrate roles for a wide range of organisations to achieve this set out what key partners have already pledged to do in support of our ambitionOverarching themes:Tackling inequalities: identifying approaches and targeting to achieve this

Partnership: need system leadership at all levels across government, health system, voluntary sector and beyondLocal leaders: change and implementation is influenced and driven by local professionals

www.gov.uk/government/publications/high-blood-pressure-action-plan

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Tackling high blood pressure

Prevention (1 of 2)

High blood pressure is preventable, and risk of cardiovascular disease is reduced down to a threshold of 115/75mmHg

Key risk factors include excess weight/salt/alcohol, physical inactivity

15% reduction in population salt intake achieved in last decade seen as main contributor to lower population blood pressure (↓3mmHg systolic)Over ten years, an estimated 45,000 quality adjusted life years could be saved, and £850m not spent on related health and social care, if England achieved a 5mmHg reduction in the average population systolic blood pressure 12Tackling high blood pressure

Detection

Prevention

Management

Prevention (2 of 2)

Key areas of focus

reducing

salt consumption and improving overall nutrition at population-level improving calorie balance to reduce excess body weight at population-level personal behaviour change on diet, physical activity, alcohol and smoking, particularly prompted through individuals’ regular contacts with healthcare & other institutions 13

Tackling high blood pressure

Detection

Prevention

Management

Potential opportunities for CCGs

integrate

prevention and lifestyle modification

into clinical

care pathways

,

eg

, physical activity, healthy eating, weight management, sensible drinking, smoking

cessation

support

behavioural change training

for

all healthcare

professionals to enable effective conversations about healthy

lifestyle

Detection (1 of 3)

Vast majority of testing occurs in primary care. In addition:

>1.4m NHS Health Checks per year (age 40-74)

Voluntary sector (e.g. “Know Your Numbers” campaign >100,000 tests/year)Pharmacy (e.g. Lloydspharmacy >65,000 tests/year)Validated self-monitoring devices at low costTesting advisable at least every five years, more frequent re-testing for those with high-normal blood pressureDiagnosis never based on a single test, normally followed by ambulatory (24 hour monitor) or home testingOver ten years, an estimated 7,000 quality adjusted life years could be saved, and £120m not spent on related health and social care costs, if England achieved a 15% increase in the proportion of adults who have had their high blood pressure diagnosed

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Tackling high blood pressure

Prevention

Detection

Management

Detection (2 of 3)

Key areas of focus

more

frequent opportunistic testing in primary care, achieved through using wider staff (nurses, pharmacy etc.), and integrating testing into the management of long term conditionsimproving take-up of the NHS Health Check, a systematic testing and risk assessment offer for 40-74 year oldstargeting high-risk and deprived groups, particularly through general practice records audit and outreach testing 15Tackling high blood pressure

Prevention

Detection

Management

Detection (3 of 3)

Potential opportunities for CCGs

identify

the local size and distribution of the shortfall in detection and review testing provision in light of this (links to CCG five year planning on reducing avoidable mortality)consider the case for investment in enhanced community pharmacy services to provide better information and support about BP managementintroduce opportunistic screening in some areasuse the medicines use review to review the blood pressure of those on anti-hypertensives and others at high risk of developing high blood pressure

Support healthcare staff to refresh skills on accurate blood pressure testing and effective results communication, including via risk communication tools e.g. QRiskII and JBS3 heart age

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Tackling high blood pressure

Prevention

Detection

Management

Management (1 of 3)

NICE recommend lifestyle treatment for all with hypertension – with good adherence can achieve dramatic blood pressure reduction

Drug therapy for all over 160/90mmHg and many below with other risks. Four-step approach to incremental drug treatment set out by NICE. 80% of people require two or more agents to achieve blood pressure

controlNICE treatment target (for adults under 80 years) 140/90mmHgOver ten years, an estimated 7,000 quality adjusted life years could be saved, and £120m not spent on health and social care, if England achieved a 15% increase in the proportion of adults on treatment controlling their blood pressure to 140/90mmHg or below 17

Tackling high blood pressure

Prevention

Detection

Management

Management (2 of 3)

Key areas of focus

local

leadership and action planning for system change, to tackle particular areas of local variation, and achieve models of person-centric carehealth professional support (communication, tools & incentives) to bring practice nearer to treatment guidelines where this falls shortsupport adherence to drug therapy and lifestyle change, particularly through self-monitoring of blood pressure and pharmacy medicine support 18Tackling high blood pressure

Prevention

Detection

Management

Prevention

Detection

Management

Management (3 of 3)

Potential opportunities for CCGs

promote and support clinical leadership for improvement by GPs, nurses and

pharmacists

support

whole system action planning for

primary

care

to

implement NICE guidance particularly

step-wise

treatment increasing number of

agents

lifestyle

changes to reach

control

regular

review of hypertensive

patients

full

assessment and initiation of

BP treatment

in those at high CVD risk

embed

management of high blood pressure within communications about long term

conditions

support

use of the Patient Activation

Measure, and commission services in response to findings to raise activation

optimise access to care of people from marginalised groups

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Tackling high blood pressure

Resource hub

PHE wants to support local leadership in tackling high blood pressure, and has gathered

resources in one hub

to help those planning and delivering high blood pressure services and initiatives 20Tackling high blood pressurewww.gov.uk/high-blood-pressure-plan-and-deliver-effective-services-and-treatment

Resources include data, guidance, tools, case studies and examples of emerging practice

The PHE team welcomes feedback and ideas for new resources to include, particularly any local case studies – please email

bloodpressure@phe.gov.uk

Healthier Lives variation atlas

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Tackling high blood pressure

healthierlives.phe.org.uk/topic/hypertension

The future

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Tackling high blood pressureWhat will we focus onWho will we work with

How will we measure our impact

What is our role in tackling

high blood pressure?