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Supported by: Understanding the Delivery of an NHS Health Check Hand-outs Booklet Accredited by: Registered office: Golden Cross House, 8 Duncannon Street, London, WC2N 4JFWhat are we trying to prevent? Genes Inflammation Risk Factors 1NHS Health Check: Best Practice Guidance Figure 2. Overview of the vascular risk assessment and management programme 23456 This is one unit of alcohol… Half pint of Half a small 1 single 1 small 1 single “regular” beer, glass of measure glass of measure of lager or cider wine of spirits sherry aperitifs …and each of these is more than one unit 2 3 4 3 9 1.5 2 Pint of Pint of“strong” orAlcopop or a 440ml can of 440ml can of 250ml glass of 75cl Bottle of “regular” beer,”premium” beer, 275ml bottle of“regular” lager “super wine (12%) wine (12%) lager or cider lager orcider regular lager or cider strength” lager AUDIT–C Scoring system Your Questions score 0 1 2 3 4 2 - 4 2 - 3 4+ How often do you have a drink containing Never Monthly times times times alcohol? or less per per per month week week How many units of alcohol do you drink on a typical day when you are drinking? 0 - 2 3 - 4 5 - 6 7 - 9 10+ How often have you had 6 or more units if Less Daily female, or 8 or more if male, on a single Never than Monthly Weekly or monthly almost occasion in the last year? daily Scoring: A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive. SCORE 7Score from AUDIT- C (other side) SCORE Remaining AUDIT questions Scoring system Your Questions score 0 1 2 3 4 How often during the last year have you found Less Daily that you were not able to stop drinking once you Never than Monthly Weekly or almost had started? monthly daily Daily How often during the last year have you failed to Less do what was normally expected from you Never than Monthly Weekly or because of your drinking? monthly almost daily Daily How often during the last year have you needed Less or an alcoholic drink in the morning to get yourself Never than Monthly Weekly almost going after a heavy drinking session? monthly daily Less Daily How often during the last year have you had a Never than Monthly Weekly or feeling of guilt or remorse after drinking? almost monthly daily Daily How often during the last year have you been Less unable to remember what happened the night Never than Monthly Weekly or before because you had been drinking? monthly almost daily Yes, Yes, but not during Have you or somebody else been injured as a No in the the result of your drinking? last last year year Yes, Yes, Has a relative or friend, doctor or other health but not during worker been concerned about your drinking or No in the the suggested that you cut down? last last year year Scoring: 0 – 7 Lower risk, 8 – 15 Increasing risk, 16 – 19 Higher risk, 20+ Possible dependence TOTAL TOTAL Score equals AUDIT C Score (above) + Score of remaining questions 8General Practice Physical Activity Questionnaire Date……………………… Name…………………….. 1. Please tell us the typeand amount of physical activity involved in your work. Please mark one box only I am not in employment (e.g. retired, retired for health reasons, unemployed, a full-time carer etc.) b I spend most of my time at work sitting (such as in an office) I spend most of my time at work standing or walking. However, my work does c not require much intense physical effort (e.g. shop assistant, hairdresser, security guard, childminder, etc.) My work involves definite physical effort including handling of heavy objects and use of tools (e.g. plumber, electrician, carpenter, cleaner, hospital nurse, d gardener, postal delivery workers etc.) My work involves vigorous physical activity including handling of very heavy e objects (e.g. scaffolder, construction worker, refuse collector, etc.) 2. During the last week, how many hours did you spend on each of the following activities? Please answer whether you are in employment or not Please mark one box only on each row None Some but 1 hour but 3 hours or less than less than more 1 hour 3 hours Physical exercise such as swimming, a jogging, aerobics, football, tennis, gym workout etc. Cycling, including cycling to work and b during leisure time c Walking, including walking to work, shopping, for pleasure etc. d Housework/Childcare e Gardening/DIY 3. How would you describe your usual walking pace? Please mark one boxonly. Slow pace Steady (i.e. less than 3mph) average pace Brisk pace Fast pace (i.e. over 4mph) Hit return to calculate PAI 9 THE NHS HEALTH CHECK AND FAMILIAL HYPERCHOLESTEROLAEMIA Why is a diagnosis of Familial Hypercholesterolaemia (FH) important? Since monogenic FH is a single gene disorder and ‘runs in families’, 50% of the brothers and sisters and 50% of the children of your FH patient are at risk of also having FH. If the diagnosis of FH is confirmed, they can easily be offered diagnostic tests and affected individuals effectively treated with statins to reduce their subsequent risk of early onset heartdisease. What should a GP do when an individual has been identified through the NHS Health Check programme with a total cholesterol of > 7.5 mmol/L? The following steps should be carried out: • Repeat the measurement on a fasting blood sample. The laboratory can then calculate the LDL cholesterol concentration. The diagnostic cut-off for a possible diagnosis of FH in an adult is a total cholesterol of > 7.5 mmol/L but more specifically an LDL cholesterol of > 4.9mmol/L. • If on the retest the LDL is >4.9 mmol/L, excludesecondary causes of hypercholesterolaemia. These are: (a) Hypothyroidism (measureTSH levels) (b) Renal impairment (measurecreatinine) (c) Obstructive liver disease (measure liverfunction tests) (d) Diabetes (using a fasting blood glucose measure) – usually associated with hypertriglyceridaemia • If secondary causes of hypercholesterolaemia have been excluded, or the patient continues to have a high cholesterol despite management of the secondary cause, then the patient should be referred to a local lipid clinic. The clinic will carry out further tests and take a detailed family history for the confirmation of the diagnosis. If not confirmed, the patient will be referred back to the GP. If confirmed the clinic will, initiate intensive statin therapy and cascade testing of affected relatives. Usually once the NICE recommend lipid lowering for FH patients is achieved (target of 50% lowering of pre-treatment LDL cholesterol) the patient will be discharged back to the GP for a shared care arrangement and agreed annual review schedule as recommended by the NICE guidelines. Click here to use the HEARTUK lipid clinic finder http://www.heartuk.org.uk/lipidclinics/index.php?/clinics/postcode/ To Note: 101 The probability of an individual having FH is increased by the degree of elevation of LDL cholesterol. While an LDL of 4.9-5.5 can be diagnostic of FH, it can also be due to “polygenic” causes. Conversely, in an individual with LDL levels over 6.0 mmol/L polygenic causes are much less likely, and a diagnosis ofFH is very much morelikely. 2 Individualswho report having relatives with either elevated cholesterol levels and or early heart disease are very likely to have monogenic FH and should definitely be referred. The NICE guideline suggests using the criteria for early CHD as under 55 years in a first degree male relative and under 65 in a first degree female relative. For other sites with information about FH See the BHF http://www.bhf.org.uk/ and for their factfile on FH see http://www.bhf.org.uk/search/results.aspx?m=simple&q=factfile+FH&subcon=BHF_main_site For the UK FH (Simon Broome ) Register see http://www.heartuk.org.uk/HealthProfessionals/index.php/simon_broome_fh_register/ For the HEARTUK Patient Support group see http://www.heartuk.org.uk/ For the NICE Guideline on FH see http://www.nice.org.uk/nicemedia/live/12048/41697/41697.pdf 11 Blood Pressure Measurement With Electronic Blood Pressure Monitors • The patient should be seated for at least 5 minutes, relaxed and not moving or speaking; • The arm must be supported at the level of the heart. Ensure no tight clothing constricts the arm; • Place the cuff on neatly with t he centre of the bladder over the brachial artery. The bladder should encircle at least 80% of the arm (but not more than 100%); • Some monitors allow manual blood pressure setting selection where you choose the appropriate setting. Other monitors will autom atically inflate and re- inflate to the next setting if required; • Repeat three times and record measurement as displayed. Initially test blood pressure in both arms and use arm with highest reading for subsequent measurement. Indication (cm)* = (cm)* = Bwidth & length (cms)(cm)*c. Small Adult/Child 10 - 12 18 – 24 12 x 18 < 23 Cuff Sizes Standard Adult 12 - 13 23 – 35 12 x 26 < 33 Large Adult 12 - 16 35 – 40 12 x 40 < 50 Adult Thigh Cuff** 20 42 < 53 * The range for columns 2 and 3 are derived from recommendations from the British Hypertension society (BHS), European ** Large bladders for arm circumferences over 42cm may be required.olumns 4 and 5 are derived from only the NHS guidelines. = Bladders of varying sizes are available so a range is provided for each indication (applies to columns 2 and 3). Points to note: It is good practice to occasionally check the monitor against other validated devices. It is important to have the monitor serviced and calibrated according to manufacturer’s guidelines. 12What do I do if & what needs to be done.. Needs to be done What do you need to do? BP >140/90 mmHg Assessment for hypertension & ABPM/Home BP <179/119 mmHg Check for DM & CKD BP >180/120 See duty Dr / ANP mmHg See GP/ANP/Pharm CVD Risk >20% Start a statin Annual review See GP/ANP/Pharm, CVD Risk 10-19% recommend a statin. If yes, annual review, if no NHS Health Check in 5 years NHS Health Check in 5 years CVD Risk <10% See GP, check full lipid profile, TC>7.5 mml/L thyroid, liver, kidney, diabetes. Consider FH See duty Dr/ANP/Pharm HbA1c >48 Diabetes prevention programme HbA1c 42-48 Lifestyle advice HbA1c 37-42 Lifestyle advice HbA1c <37 Weight management programme Diabetes prevention BMI >30 programme Complete rest of Audit C Audit C>5 Offer advice, Drink Aware app Audit C 8-19 Referral to specialist alcohol Audit C >20 services ECG Irregular pulse Smoker Stop smoking services 12Useful Websites Alcohol www.drinkaware.co.uk/for-professionals/#health www.e-lfh.org.uk/programmes/alcohol www.alcoholconcern.org.uk/unit-calculator?gclid=CImZu_3KodICFecK0wodYqcLeQ British Hypertension Society www.bihsoc.org (Great for validated BP monitors and info for ABPM & HBPM) Charities: www.heartuk.org.uk (Great for cholesterol) * supporters of our training www.bloodpressureuk.org/Home (Great patient info and blood pressure week) www.bhf.org.uk www.diabetes.org.uk CVD Risk Calculators www.nhs.uk/conditions/nhs-health-check/pages/check-your-heart-age-tool.aspx www.jbs3risk.com/pages/risk_calculator.htm Dementia Leaflet www.healthcheck.nhs.uk/commissioners_and_providers/training/dementia_training www.healthcheck.nhs.uk/commissioners_and_providers/marketing/dementia_resources NHS Health Checks – template letters, posters and data & statistics www.healthcheck.nhs.uk www.healthcheck.nhs.uk/commissioners-and-providers/national-guidance/ www.healthcheck.nhs.uk/commissioners-and-providers/training/competency-framework-and-learner-and- assessor-workbooks/ RCN - Accountability and Delegation www.rcn.org.uk/professional-development/accountability-and-delegation Free e-Learning www.e-lfh.org.uk/programmes/all-our-health Better Health (was One You) www.nhs.uk/better-health/ Computerized Brain Games www.stayingsharp.aarp.org/about/brain-health/games www.lumosity.com www.brainHQ.com Skills for Health www.skillsforhealth.org.uk/info-hub/category/the-care-certificate/ Obesity www.cks.nice.org.uk/topics/obesity/diagnosis/identification-classification Free LWN Webinars www.learnwithnurses.org