post-mi care

7. Research conducted on behalf of the Steering Group published in BJC in May / June 2009 issue Research paper is available as a readable PDF document in the online toolkit Research conducted on behalf of the Steering Group published in BJC in May / June 2009 issue Research paper is available as a readable PDF document in the online toolkit

8. Guidance published in the July / August 2009 issue of the BJC Guidance paper is available as a readable PDF document in the online toolkit Guidance published in the July / August 2009 issue of the BJC Guidance paper is available as a readable PDF document in the online toolkit

26. Best practice discharge summary available as part of online toolkitBest practice discharge summary available as part of online toolkit

27. PDFs of the HCP and patient tools are provided in the online toolkit – along with details of how to order hard copy versions for use in your own practicePDFs of the HCP and patient tools are provided in the online toolkit – along with details of how to order hard copy versions for use in your own practice

30. For group presentations: You may wish to make this a discursive group exercise, with participant responses being scribed on a flip chart For group presentations: You may wish to make this a discursive group exercise, with participant responses being scribed on a flip chart

40. Guidance meets the desired objectives – and case studies demonstrate that it is practical and user-friendly Guidance meets the desired objectives – and case studies demonstrate that it is practical and user-friendly

41. For group discussion only: The following slides are intended to facilitate group discussion about challenges HCPs may face relating to implementation of the Follow Your Heart guidance, and solutions for overcoming these barriersFor group discussion only: The following slides are intended to facilitate group discussion about challenges HCPs may face relating to implementation of the Follow Your Heart guidance, and solutions for overcoming these barriers

42. Suggested format: Facilitated group brainstorm. Identified barriers can be scribed on flip charts for reference in the following section Suggested format: Facilitated group brainstorm. Identified barriers can be scribed on flip charts for reference in the following section

43. Suggested format: Split participants in to smaller groups, allocate each with a set of challenges and encourage suggestions for how to overcome these barriers. Discussion can then be presented back to the wider groupSuggested format: Split participants in to smaller groups, allocate each with a set of challenges and encourage suggestions for how to overcome these barriers. Discussion can then be presented back to the wider group

44. Suggested format: Facilitated group brainstormSuggested format: Facilitated group brainstorm

48. Qualitative research project to understand some of the reasons for reported variation in care and treatment of post-MI patients around the UK Specifically interested in standards of care once patients have been discharged from hospital Agreement amongst steering committee that regional variation may be owing in part to multiple inconsistent clinical guidelines Research project sought to understand variation in availability and content of local post-MI guidelines, as well as regional variations in clinical practice Both phases focussed on five key areas, identified by the Steering Committee as relevant to care and treatment of post-MI patients Qualitative research project to understand some of the reasons for reported variation in care and treatment of post-MI patients around the UK Specifically interested in standards of care once patients have been discharged from hospital Agreement amongst steering committee that regional variation may be owing in part to multiple inconsistent clinical guidelines Research project sought to understand variation in availability and content of local post-MI guidelines, as well as regional variations in clinical practice Both phases focussed on five key areas, identified by the Steering Committee as relevant to care and treatment of post-MI patients

49. Methodology Search to identify guidelines available online PCTs Cardiac networks (CNs) Telephone interviews with cardiac networks to identify additional guidelines not available online and better understand uptake and implementation of guidelines Online survey of 1,003 UK primary care clinicians27 802 GPs and 201 practice nurses Establish awareness of locally developed guidelines, use vs. national guidelines and identify areas of variation in clinical practice To understand what locally-developed guidelines are available, a survey of PCT and cardiac network websites in England was conducted Guidelines were analysed for five key areas previously identified NB. Cardiac networks were identified through NHS Heart Improvement website Online survey of 61 questions Recruitment weighted to include proportional numbers of clinicians from SHA regions in England, as well as Northern Ireland, Scotland and Wales To understand what locally-developed guidelines are available, a survey of PCT and cardiac network websites in England was conducted Guidelines were analysed for five key areas previously identified NB. Cardiac networks were identified through NHS Heart Improvement website Online survey of 61 questions Recruitment weighted to include proportional numbers of clinicians from SHA regions in England, as well as Northern Ireland, Scotland and Wales

50. Results – Availability and Awareness of Local Guidelines Research 15 local post-MI guidelines identified 8 PCT developed 7 CN developed Where local guidelines not available, CNs typically recommend following NICE Survey 60% of clinicians aware of local guidelines in their area Map shows number of available locally-developed guidelines according to SHA region in England N.B. Although 60% of survey respondents indicated that they were aware of local guidelines in their area, 49% of those indicated that guidelines were developed by local hospitals – and may therefore not be relevant to the ongoing care of patients following discharge to primary careMap shows number of available locally-developed guidelines according to SHA region in England N.B. Although 60% of survey respondents indicated that they were aware of local guidelines in their area, 49% of those indicated that guidelines were developed by local hospitals – and may therefore not be relevant to the ongoing care of patients following discharge to primary care

51. Results – Content of guidelines / relevance to clinical practice The following slides show: The content of local guidelines identified, i.e. How many of the guidelines included recommendations on this aspect of post-MI care, and what were those recommendations? Key survey findings about each of these elements of post-MI care, indicating trends in clinical practice The following slides show: The content of local guidelines identified, i.e. How many of the guidelines included recommendations on this aspect of post-MI care, and what were those recommendations? Key survey findings about each of these elements of post-MI care, indicating trends in clinical practice

56. Results - Guideline Implementation Research CNs feel they can only offer clinicians guidance Implementation of CN developed guidelines limited and variable - methods include: Distribution to every practice OR individual clinician in the area Distribution only on request Embedding in GP operating systems Training events Survey 27% of clinicians feel ‘obliged’ to follow local post-MI guidelines Where applicable, enforcement predominantly through practice (48%) or PCT-led (39%) audits and alignment to QOF (39%) When interviewed, all cardiac networks indicated they can only offer clinicians guidance, rather than make following any particular protocol mandatory Implementation of cardiac network developed guidelines is limited – interviews indicated that resourcing is a problem However, over a quarter of clinicians feel obliged to follow local post-MI guidelines When interviewed, all cardiac networks indicated they can only offer clinicians guidance, rather than make following any particular protocol mandatory Implementation of cardiac network developed guidelines is limited – interviews indicated that resourcing is a problem However, over a quarter of clinicians feel obliged to follow local post-MI guidelines

57. Conclusions Considerable regional variation in guidelines followed Little consistency in availability, content and implementation of local post-MI guidelines May contribute to significant variation in clinical practice, as reported by HCPs In some areas, patient care may not be optimal

58. References Sivers, F et al. Follow your heart: optimal care after a heart attack – a guide for you and your patients. Br J Cardiol 2009;16:187-91 Ong S, Milne D and Morrell J (on behalf of the Follow Your Heart Steering Committee). Post-MI clinical guidelines: Variation in availability, development, content and implementation across the UK. Br J Cardiol 2009; 16:142-146 British Heart Foundation. Healthcare and economic costs of CVD and CHD. Available from: http://www.heartstats.org/datapage.asp?id=101 [accessed May 2009] Food Standards Agency. Healthy diet. Available from: http://www.eatwell.gov.uk/healthydiet/ [accessed May 2009] HEART UK. Healthy eating fact sheet D10: Mediterranean diet. Available from: http://www.heartuk.org.uk/images/uploads/healthylivingpdfs/HUK_factsheet_D10_MediterraneanDiet.pdf [accessed May 2009] Food Standards Agency. Saturated fat. Available from: http://www.eatwell.gov.uk/healthydiet/fss/fats/satfat/ [accessed May 2009] HEART UK. Healthy eating factsheet D04. Available from: http://www.heartuk.org.uk/images/uploads/healthylivingpdfs/HUK_factsheet_D04_fruitVeg.pdf [accessed May 2009]