Exercise referral Elaine McNish Director of BHFNC British Heart - - PowerPoint PPT Presentation

Exercise referral

Elaine McNish –Director of BHFNC

British Heart Foundation National Centre for Physical Activity and Health

Presentation

• Role of NIHCE and physical activity

guidelines

• Background to Exercise Referral

guidelines

• Implications and areas to consider
• Models of delivery
• Opportunities

Role of NIHCE

• Producing evidence based guidance and

advice for health, public health and social care practitioners.

• Developing quality standards and

performance metrics for those providing and commissioning health, public health and social care services.

• Providing a range of informational services

for commissioners, practitioners and managers across the spectrum of health and social care.

Role of NIHCE

• NICE products and resources are produced

for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing public health and social care services.

• The guidance is expected to be taken into full

consideration by health and social care professionals and organisations when making decisions with the person receiving

• care. However, it is not designed to replace

the knowledge and skills of individual professionals.

NIHCE Public Health Guidance on PA

• Evidence based
• Effective
• ‘Exceptional value for money’

[NICE & Department of Health]

Evidence of what works is increasing

A selection of national guidelines recommending physical activity in prevention and management of LTCs..?

More……

Falls Chronic Kidney Disease Premenstrual syndrome Osteoarthritis Chronic Lower Back Pain

Osteoporosis

Cellulitis in lymphedema

Physical activity promotion

• ptions

Intervention Spectrum

31 The commissioning landscape: the state of play

Universal

Open access physical activity services e.g. leisure Utility based activity resources

Targeted

Demographic targeted open access e.g. women, disabled individuals and communities

Specialist

Disease-specific groups Rehabilitation programmes Integrated behaviour change programmes

Universal Targeted Specialist services

NICE Exercise Referral Guidance – considerations

• The review did not cover ongoing management or

rehabilitation following certain health conditions e.g. CHD

• There was a always a consideration of cost effectiveness

especially in relation to other options

• The evidence base had not moved on much from the

previous review – not many high quality studies measuring long term impact

• Challenges in defining exercise referral - lots of different

models and different terminology

• Recognition that the main outcome may not be health

but no studies to be definitive on impact – need evaluation

• Draft guidelines were field tested
• This is but one intervention in a suite of NICE guidelines
• n physical activity

Definition

• An assessment to determine activity levels
• Referral by health professional to physical

activity specialist

• Personal assessments involving a

specialist service to determine programme

• Opportunity to participate in a programme

NICE Public Health Guidance 54: ERS

Recommendation 1:

• Policymakers and

commissioners should not fund ERS for people who are sedentary or inactive but

• therwise apparently healthy
• Primary Care Practitioners

should not refer people who are sedentary or inactive but

• therwise apparently healthy

to ERS

NICE Public Health Guidance 54 :ERS

Recommendation 2:

• Policymakers and

commissioners should only fund ERS for people who are sedentary or inactive and have existing health conditions or other factors that put them at increased risk of ill health

Caveats:

• Incorporates core techniques
• f NICE Behaviour Change PH

Guidance 49

• Collects data in line with the

essential criteria outlined in NOO Standard Evaluation Framework for physical activity interventions

• Makes the data collected

available for analysis, monitoring and research to inform future practice

Robust evaluation vital to secure ££

Evaluation of physical activity interventions has been notoriously weak

• Poor evaluation design
• Process – Impact - Outcomes
• Limited long-term follow-up

Ayrshire & Arran Model

NERS Final Chronic Condition Referral Routes & Delivery Options

Back Pain 16-32 week programme

Condition specific referral form completed and sent to NERS Coordinator Condition specific Specialist Physiotherapist /Occupational Therapist Condition specific form completed and sent to NERS coordinator

NERS 1:1 Baseline Assessment; Health Questionnaire/Informed Consent Goal Setting Assessment tools selected from; TUAG 10 M Walk EQ-5D FACIT Fatigue SPAQ etc.

GP / AHP

NERS Level 4 Chronic Condition Referral Routes and Delivery Options

Depending on assessment outcomes and impairments present; NERS Coordinators checks referral and assigns to EP

Community Respiratory Post Rehabilitation 16-32 week programme Phase IV Cardiac Rehabilitation 8-16 week

programme

Obesity/ Diabetes 16- 32 week programme Stroke 16- 32 week programme

Conditions are suitable for combined delivery in either exit route sessions or with green partner schemes following 4th / 8th week review Conditions possibly suitable for combined delivery of evidenced based PSI FaME and Otago

Mental Health 16- 32 week programme 16 week NERS Level 3 programme Cancer 16- 32 week programme PSI Falls Prevention 48 week programme

BHFNC exercise referral toolkit

Guidance for:  Referring healthcare professionals  Exercise professionals  Scheme coordinators  Commissioners Plus:

 A guide to evaluating ERS  A guide to qualifications  Templates forms/letters

www.bhfnc- exercisereferral.org.uk

Opportunities

• NHS Diabetes Prevention Programme:

Providers to deliver structured behavioural change interventions for people at risk of diabetes www.england.nhs.uk/ndpp

• NHS Health Checks:
• Need exit strategies/interventions to support

those at risk of CVD

• Wider offer – span intervention spectrum

More systematic & proactive management of Long term conditions (LTCs)

15 million people in England living with at least

• ne long term condition

2025 - 18 million

Counting the cost of LTCs

Approximately 50% of GP appointments 64% of outpatient appointments 70% of inpatients bed days

1 LTC = £1,000 2 LTCs = £3,000 3 LTCs = £8,000

How do we capitalise?

• Effective screening method so referral and signposting

can occur – PARQ

• Better evidence based practice – improve adherence
• Right level of intervention for right patient
• Training for health professionals – or make it easy for

them

• Educate and encourage self management
• Training qualification review
• Understand the needs of inactive and meet their

needs – more choice- right offer; right place; right time

• Collect evidence of impact but also best practice

Thank you bhfactive.org.uk