AMP ( Angina Management Programme) Chesterfield Refractory Angina Centre Dr PJ Flann, Dr Clare...
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Transcript of AMP ( Angina Management Programme) Chesterfield Refractory Angina Centre Dr PJ Flann, Dr Clare...
![Page 1: AMP ( Angina Management Programme) Chesterfield Refractory Angina Centre Dr PJ Flann, Dr Clare Hawley Dr Kath Markus & Cardiac Specialist Nurse Karen Dunn.](https://reader035.fdocuments.us/reader035/viewer/2022081501/56649e6a5503460f94b67499/html5/thumbnails/1.jpg)
AMPAMP((Angina Management Programme)Angina Management Programme)
Chesterfield Refractory Angina CentreChesterfield Refractory Angina Centre
Dr PJ Flann, Dr Clare HawleyDr PJ Flann, Dr Clare HawleyDr Kath Markus &Dr Kath Markus &
Cardiac Specialist Nurse Karen Dunn Cardiac Specialist Nurse Karen Dunn
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Why am I here ?Why am I here ?
AMP – is something different AMP – is something different
We talk to patients We talk to patients
We inform and educate them We inform and educate them
We save money We save money
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Todays’ RemitTodays’ Remit
Improve Quality Improve Quality
InnovativeInnovative
Saves money Saves money
Is Preventive Is Preventive
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The Beginning The Beginning Training via NRAC & Prof Mike Chester Training via NRAC & Prof Mike Chester
Training 08Training 08
Chesterfield AMP Start 1/1/09Chesterfield AMP Start 1/1/09
Target of 50 patients for the first year. Target of 50 patients for the first year.
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Why ?Why ?
Everyone wins Everyone wins
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Why ?Why ?
Patient’s benefit Patient’s benefit
Cost savings Cost savings
Evidence Evidence
Government agendaGovernment agenda
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Patient Benefits Patient Benefits
Quality of life Quality of life
DepressionDepressionNumber MI’sNumber MI’sAdmissionsAdmissionsNumber interventions Number interventions (( & complications )& complications )
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Cost SavingsCost Savings(NRAC results )(NRAC results )
On Admissions On Admissions (15.5 bed days to 10.34)(15.5 bed days to 10.34)
MI’s + admissionsMI’s + admissions (14% to 2.3%) (14% to 2.3%)
ProceduresProcedures (86% would not choose (86% would not choose surgery) surgery)
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Nice – cost per QALYNice – cost per QALY
ExerciseExercise £440£440
BypassBypass £19000£19000
AngioplastyAngioplasty £47000£47000
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EvidenceEvidence
CourageCourage - no benefit of PCI in - no benefit of PCI in stable anginastable angina
CBTCBT - Reduces admissions- Reduces admissionsLifestlyeLifestlye - Reduces angina- Reduces anginaCost effectiveCost effective - Griffin et al - Griffin et al QOLQOLMisconceptions Misconceptions - reduces MI’s- reduces MI’sCollateralsCollaterals
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Government AgendaGovernment Agenda““Improve healthcare by reducing Improve healthcare by reducing unnecessary waste” Hewitt /06unnecessary waste” Hewitt /06
NHS operating Framework - NHS operating Framework - supporting people with longterm supporting people with longterm conditionsconditions
““Our Health , Our say “ Our Health , Our say “ care closer to home care closer to home
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What we DoWhat we Do
Listen & Educate patients Listen & Educate patients (rare nowadays)(rare nowadays)
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What we do What we do
Angina is GoodAngina is Good
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What we do What we do
Assess individual symptoms Assess individual symptoms
Establish their beliefs and misconceptionsEstablish their beliefs and misconceptions
Explain collateral development Explain collateral development
Explain pre-conditioningExplain pre-conditioning
Explain pain and nerve pathwaysExplain pain and nerve pathways
Help them control angina with relaxation Help them control angina with relaxation
Give lifestyle advice Give lifestyle advice
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MisconceptionsMisconceptions
““angina damages the heart”angina damages the heart”
““angina is a kind of mini heart attack”angina is a kind of mini heart attack”
““angina is due to back pressure in the angina is due to back pressure in the heart” heart”
““the arteries are furring up and will the arteries are furring up and will eventually block and I’ll die “eventually block and I’ll die “
It is important to avoid anything that It is important to avoid anything that brings on angina”brings on angina”
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What we do What we do
We empower the patient We empower the patient to take control of decisions to take control of decisions
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How How
Time Time
2hrs individual time 2hrs individual time
4x2 hrs in group sessions4x2 hrs in group sessions
1 hr follow up1 hr follow up
1hr annual follow up 1hr annual follow up
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Our Cost Our Cost
£2000 per patient £2000 per patient
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Chesterfield ResultsChesterfield Results
25 patients -2 cohorts25 patients -2 cohorts
6 x PCI saved6 x PCI saved
3 x CABG saved 3 x CABG saved
1 Angiogram1 Angiogram
All improved with programmeAll improved with programme
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SavingsSavings
£43,888 in procedures£43,888 in procedures( not including a transplant ) ( not including a transplant )
£40,221 on hospital activity£40,221 on hospital activity
Total £84,109Total £84,109
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After Cost After Cost
25 Patients £52,25025 Patients £52,250
Overall saving = £31,859Overall saving = £31,859
£1,274 per patient £1,274 per patient
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Our SatisfactionOur Satisfaction
Patients all have less anxietyPatients all have less anxiety
Patients all have less anginaPatients all have less angina
Fantastic patient satisfaction resultsFantastic patient satisfaction results
Number patients cry with relief Number patients cry with relief
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ReferralsReferrals
CardiologyCardiology- new cardiac patients - new cardiac patients - longstanding difficult patients- longstanding difficult patients
GP’s GP’s - frequent flyers- frequent flyers- difficult patients - difficult patients
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Problems Problems
Cost of training Cost of training
Time for training (8 days )Time for training (8 days )
GP enthusiasmGP enthusiasm
Pilot set up to train not save moneyPilot set up to train not save money
Convincing the PCT board Convincing the PCT board
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Problems Problems
Consultants Consultants
GP referralsGP referrals
Correct patients Correct patients
Waiting list -DNA’sWaiting list -DNA’s
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Present DayPresent Day
Running for 18 mthsRunning for 18 mths
Contract for 4 yrs from PCTContract for 4 yrs from PCT
Interest from Sheffield + Derby Interest from Sheffield + Derby
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This is the futureThis is the future
DOH wants this rolled out DOH wants this rolled out
New NICE guidelines on the way New NICE guidelines on the way
Stents are now ethically challenged Stents are now ethically challenged
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TestimonialsTestimonials““Looking back I shudder to think where I would be now Looking back I shudder to think where I would be now without these sessions. I expect more visits to my GP and without these sessions. I expect more visits to my GP and hospital coupled with yet more medication” - Patienthospital coupled with yet more medication” - Patient““Since you explained it, I have felt more reassured and Since you explained it, I have felt more reassured and confident that the underarm pain I experienced was not confident that the underarm pain I experienced was not related to Angina and don’t now feel I need to call the related to Angina and don’t now feel I need to call the emergency services.” - Patientemergency services.” - Patient““If, in the near future, I was offered stenting or re-grafting I If, in the near future, I was offered stenting or re-grafting I would be very reluctant to have any more invasive would be very reluctant to have any more invasive procedures carried out”. - Patientprocedures carried out”. - Patient““My wife benefited too by learning how to relax and knows My wife benefited too by learning how to relax and knows she doesn’t need to panic when I have an attack. She she doesn’t need to panic when I have an attack. She enjoys having my company on dog walks too” - Patientenjoys having my company on dog walks too” - Patient
He now understands the risk/benefits of further intervention He now understands the risk/benefits of further intervention when, previously, he was pushing for bypass and I don’t when, previously, he was pushing for bypass and I don’t need to see him again in my clinic - Consultantneed to see him again in my clinic - Consultant