Shared learning database
Type and Title of Submission
Prosiect Sir Gar - Workplace cardiovascular (Diabetes and CHD) health assessment and management programmeDescription:
Prosiect Sir Gār is one of the first programmes of its kind to engage with occupational health services to use the workplace as the setting for identifying and managing increased cardiovascular risk. Launched in March 2009, Prosiect Sir Gār is considered a pioneer project with a strong partnership between Hywel Dda Health Board (HDHB), Public Health Wales, Carmarthenshire County Council, Tata Steel Works (Trostre), Swansea University (School of Medicine) and the Pharmaceutical Industry. As government policy focuses increasingly on prevention and management, members from the project board identified the need to develop a co-ordinated approach towards tackling the unacceptable levels of CVD within Carmarthenshire.Does the submission relate to the general implementation of all NICE guidance?
YesDoes the submission relate to the implementation of a specific piece of NICE guidance?
NoFull title of NICE guidance:
PH38 - Preventing type 2 diabetes: risk identification and interventions for individuals at high riskIs the submission industry-sponsored in any way?
The programme is a partnership between Hywel Dda Health Board, Swansea University, TaTa Steel, Carmarthenshire County Council and Public Heath Wales. The pilot phase was supported by funding from a group of Pharmaceutical companies.
Description of submission
Aims and objectives
The aim of the project is to identify staff within a workplace setting, who are most at risk of developing cardiovascular disease (CVD) and offer those at high risk intensive support to make lifestyle improvements where necessary.Context
Cardiovascular disease (CVD) is the leading cause of premature death in Wales. The main forms of CVD are coronary heart disease (CHD), stroke, diabetes and kidney disease (BHF, 2010). In Wales, around 232,000 people are living with CVD. Although deaths from CVD have been falling, CVD still kills more people in Wales than any other disease (BHF, 2010).
Preventive strategies and risk assessment are topics of considerable interest in the clinical community and the focus on the need for prevention has become sharper in recent years. In March 2008 the UK National Screening Committee reported that screening certain subgroups of the population who are at high risk of Type 2 diabetes is feasible, but it should be undertaken as part of an integrated programme to detect and manage cardiovascular risk factors. As Government policies focus is increasing on prevention and management through guidelines and targets, members from the project board identified the need to develop a co-ordinated approach towards tackling the unacceptable levels of CVD within Carmarthenshire. In particular, the project board believed that occupational health services could offer an excellent opportunity to provide primary prevention cardiovascular risk assessment and management to the workforce in Carmarthenshire.
Staff working in Tata Steel Works and in Hywel Dda Health Board (Carmarthenshire hospitals) were either invited or requested an appointment with their occupational health services. The content and format of the health check is covered in a comprehensive Standard Operating Procedure (SOP), which has been developed to ensure that each health check complies with clinical governance requirements and best practice. To summarise each health check lasted between 20-40 minutes, this would obviously vary pending upon the individuals risk outcome.
A number of clinical measurements as well as lifestyle questions were recorded. The questions and measurements were broken down under the following headings:
- Blood pressure
- Pulse rate
- Blood measurements
- Performing the finger stick puncture
- Performing the HbA1c and cholesterol test (Point of care testing)
- Height measurement
- Weight measurement
- Body mass index
- Waist circumference
- QRISK2 & QRISK (CVD risk calculator)intervention for diabetes
- Lifestyle questions
- GPPAQ (General Practice Physical Activity Questionnaire)
- Smoking status
- Alcohol consumption
- Stress management
Staff identified as being at high risk of developing CVD were referred into an intensive lifestyle change programme. This includes an 8 week intervention with the project dietitian and exercise specialist, with specific focus on behaviour change. They were also referred to the GP for further investigations and/or medical intervention. Those with isolated risks such as hypertension, increased blood cholesterol or HbA1c levels were referred directly to their GP for appropriate medical intervention and support.
Overall, the project to date has demonstrated that the workplace is a feasible setting for early intervention and that occupational health services are an appropriate service in which to provide cardiovascular health checks. The project has worked in partnership with Swansea University and 2 PhD students will be analysing and validating the data (using both qualitative and quantitative methods).
The results to date have reported 819 employees have received a health check in their workplace (583 = NHS staff from Hywel Dda Health Board and 236 = steel workers from Tata steelworks).
Feedback from participants:
-'It was reassuring to have the tests and to know what action was necessary to improve my fitness levels'
-'It was a wake up call, makes you take stock'
-'Convenient to have in the workplace'
-'Excellent view point on existing health condition. Worthwhile attending and now have a baseline for future monitoring'
Undertaking CVD risk assessment and management in a workplace is complex and multi-facetted, which requires significant management, organisational support and stakeholder commitment and involvement. Here are some lessons learnt and key success factors that are required to ensure this approach is used to its best potential:
- Good communication between the different project partners and with support services.
- Use of up to date evidence based guidelines through the development of a standard operating procedure.
- Good monitoring and audit systems.
- Competent trained staff to deliver the service.
- Knowledge and skills needs assessment with the appropriate training pack.
- Roles and responsibilities are clearly defined and members have signed up and committed resource to the project prior to starting.
- Key members of staff are identified with the relevant skills, appropriate seniority and authority to make decisions and have sufficient time to dedicate to the project.
- A Project Board which is made up of relevant stakeholders to ensure that both project planning and implementation is systematic and sustainable.
- All of the project databases should be compatible to allow data to be extracted and evaluated with ease.
- Data collection and entry are incorporated into the project protocols and procedures at the beginning of the project.
- Clearly defined outcome measures should be developed for the project as a whole.
- Integrate the project into local strategic planning.
- This project was implemented prior to publication of the NICE guidance and contains useful learning points. All aspects of this intervention are not in line with what NICE recommends and users should always refer to the original guidance as the only definitive statement of the guidance.
View the supporting material
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This page was last updated: 26 June 2012