Overview patient-centred angina services

Professor Mike Chester, Director of the National Refractory

Angina Centre

Person-centred service delivery

“NRAC’s involvement of patients and carers at every stage of the development of their care is something from which the rest of the NHS could learn”

–Jan 2003 Health Commission report

Specialist clinic TWO - THREE hours

Diagnosis: involves patient & carers

»Includes how the angina prevents them

getting what they want

- Agree realistic objectives/compromises

- Explain ‘angina’ and correct misconceptions

- Work out a plan

Professionally prepared ‘homework’ and classes

Results

Angina and Quality of Life after one year of patient-centred care

Improvement p

Angina stability 33% .03

Angina frequency 30% .02

QoL 35% .001

(Moore R et al . Eur J Pain. 2005 Jun;9(3):305-10)

Followed 271 patients for a year before and after coming to NRAC

We counted every hospital admission each month and

averaged the monthly admission days

Moore RK et al., J Pain Symptom Manage. 2007 Mar;33(3):310-316

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271enrolment

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271enrolment

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271enrolment

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271enrolment

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271enrolment

Month 0 Month 10

Monthly Days In Hospital before and after enrolment in NRAC

0

.5

1

1.5

2

2.5

Days in hospital per month

n=271

≈70% Savings

enrolment

Month 0 Month 10

Other patient-centred angina clinics

Chesterfield

Dr Alan Cohen FRCGP, National Primary Care Advisor

Chesterfield

Dr Alan Cohen FRCGP, National Primary Care Advisor

“…based on the ground-breaking work at the National Refractory Angina Centre...”

Chesterfield Results

25 patients -2 groups

Dr Alan Cohen FRCGPNational Primary Care Advisor

All improved with programme 6 x stent procedures avoided 3 x bypasses avoided 1 Angiogram avoided Several admissions avoided

Total Savings

• £43,888 in avoided procedures

• £40,221 saved on hospital activity

• Total saving = £84,109 in 25 patients

Dr Alan Cohen FRCGPNational Primary Care Advisor

Net savings

• 25 Patients

• Overall saving =£31,859

(£84,109 savings minus £52,250 costs)

• £1,274 net saving per patient

Dr Alan Cohen FRCGPNational Primary Care Advisor

Wirral clinic first twenty patients’

experiences

• Corrected misconceptions

• Reduced anxiety

• Encouraged health promoting

behaviours

All patients wished they had

come sooner and

all would recommend the

service to all angina patients

Comments/Improvements: Wirral

• “Fantastic”• “Why did we have to wait so long?”• “The atmosphere was great”• “Everyone listens and explains”• “More of the same for other

patients”• “Nothing to add-Perfect! Thank

you”

Chesterfield

Dr Alan Cohen FRCGP, National Primary Care Advisor

Chesterfield

Dr Alan Cohen FRCGP, National Primary Care Advisor

What patients say

Chesterfield

Dr Alan Cohen FRCGP, National Primary Care Advisor

Patient-centred angina care

Summary

• improves quality of lifeimproves quality of life11

• reduces angina frequency and reduces angina frequency and severityseverity11

• improves functionimproves function22

• reduces hospital admissionsreduces hospital admissions33

• reduces incidence of MIreduces incidence of MI33

1. Moore R et al., Eur J Pain. 2005 Jun;9(3):305-10) 2. Moore R et al., J Pain & Symptom Management;33(3):310-316 3. Furze J et al., Psychosomatic Res 2005 59: 323-29

reduces demand for palliative cardiac procedures (bypass and stents)1,2,3

1. Eur Heart J 1997;18:394-4132. Lewin et al., British Journal of Cardiology 1995; 2(8):

221-2263. Ornish D. Am J Cardiol. 1998 Nov 26;82(10B):72T-76T.

Educated patients

and carers love the

patient-centred

experience

www.angina.org

Thanks for taking the time