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Share The Pressure - Using Heart Age

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Summary

This on-demand teaching session is relevant to medical professionals and will provide them with an overview of the Share the Pressure project and the use of heart age tools to evaluate blood pressure (BP) risk. They will gain insight into the project's research and results, as well as understand how it could be adapted to other populations. Additionally, they will have an opportunity to learn how to use the publicly accessible website and apply it to their own practice. Through this session, they will gain understanding of how to effectively use the heart age tool to communicate risk to patients and help them make decisions about BP management.
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Description

Join CVD nurses Michaela Nuttall RGN MSc and Joanne Has RN MSc with guest appearances on some webinars from David Okoro for a series of webinars on Blood Pressure

Delivered as a 40-minute bitesize webinar, all attendees can participate via chat (verification of HCP status needed), and certificates for CPD are available on submission of evaluation.

The webinar will be available on demand after the event and all registrants will be notified when it is published.

About Share The Pressure:

Share The Pressure has been developed as part of a joint initiative by Smart Health Solutions, The Race Equality Foundation and Younger Lives to raise awareness of raised blood pressure in Black African and Caribbean people, to encourage and support them to seek help for raised blood pressure and to promote shared decision making with healthcare professionals in managing raised blood pressure together.

How can it help my patients?​

Patients can take an assessment on a specially designed website, including scientifically validated ‘heart age’ scores and receive a report which will contain evidence-based recommendations and advice underpinned by proven behaviour change techniques.  The purpose of the whole process is to help inform and prepare patients for their consultations, whether in person or remotely, and for shared decision making around managing their blood pressure. Shared decision-making between patients and healthcare professionals has been shown to support adherence to treatment plans and improves patient experience and outcomes.​ Share The Pressure is designed to support that process

How can it help me?​

As well as benefitting your patients Share the Pressure provides a wealth of resources and tools to support healthcare professionals in the management of blood pressure. Share the Pressure also provides high quality learning opportunities to support your own continuing professional development and any revalidation requirements.

Find out more on our website by clicking here

About the Speakers:

Michaela Nuttall RGN MSc

Michaela is a Cardiovascular Nurse Specialist with a unique and varied experience across the NHS and beyond.

She developed her passion for prevention over 20 years ago and has worked within it ever since. In 2016 she left public health after working in the field for 16 years and now focuses on 3 main areas, as a Director for Smart Health Solutions, Associate in Nursing for C3 Collaborating for Health and Head of CVD Prevention at the Office for Health Improvement and Disparities (Public Health England.

She is the Chair of the Health Care Committee of Heart UK and an invited member of both the Nurses and The Guidelines and Information working party of the British and Irish Hypertension Society, elected member of the Association of Cardiovascular Nurses and Allied Health Professional Education working party, on a variety of editorial boards and the Global Cardiovascular Nursing Leadership Forum. Being a Trustee at PoTS UK keeps her firmly rooted in the challenges patients face in living with life-altering conditions.

Joanne Haws RN MSc

Joanne Haws is a cardiovascular specialist nurse and has worked in a variety of roles across primary and secondary care over the past 20 years. In 2010 she set up in business as an independent nurse consultant delivering clinical, educational and consultancy services to a number of NHS, charitable and commercial organisations across the UK.

As a former Clinical Lead for Education for Health, Joanne passionately believes in educating healthcare professionals to improve patient care. Joanne held the position of Chair of the Cardiovascular Nurse Leaders’ (CVNL) Forum of the Primary Care Cardiovascular Society from 2010 – 2012 and is the current Chair of the Nurses and Allied Health Professionals working Party of The British Hypertension Society.

She is also an Education Committee member of The European Society of Cardiology Council for Cardiovascular Nurses and Allied Health Professionals. Joanne sits on the Editorial Board of the General Practice Nurse (GPN) journal and has authored many publications in the nursing and cardiology press both in the UK and internationally.

Since 2015 Joanne has been actively involved in the transformation of Primary Care and the development of Primary Care Networks. She is a member of the National Association of Primary Care’s (NAPC) Primary Care Home Faculty and a Clinical Associate for South Norfolk Healthcare GP Provider Organisation.

Joanne recently returned to her roots as a Critical Care Nurse to help support the COVID-19 response.

David Okoro

David Okoro is an Education Consultant, Coach and Trainer who designs his own programmes and works with young people and adults in schools, colleges, universities, business and community organisations.

He is passionate about delivering a holistic training approach, incorporating wellbeing and physical health. In particular, David has a keen interest in mental health, especially amongst BAME communities.

David has delivered programmes to over one hundred thousand people in the UK and abroad.

David has also advised government departments (including Department for Communities and Local Government and Cabinet Office), and was a key contributor to the Reach Report. He is a school governor and use to run his own charity which provided scholarships, text books, exercise books and pencils for young people in West Africa (Sierra Leone and Nigeria).

David is the founder and director of Westside and Lewisham Young Leaders academies. Their role is to provide leadership and educational opportunities to young people, and raise their confidence and aspirations.

David was also the chairperson of the Anthony Walker Foundation (a charity promoting diversity and tackling hate crime), and was a director of the Nubian Times Newspaper.

Learning objectives

Learning objectives: 1. Understand the different risk factors associated with cardiovascular disease for Black African and Caribbean people 2. Appreciate the importance of using heart-age tools to support communication and decision making around high blood pressure management 3. Identify the main areas of discussion from various focus groups used in the Share the Pressure project 4. Utilise the Share the Pressure website and heart age tool to support patients in understanding their risk factors 5. Develop the ability to analyse and discuss the advantages of the heart age tool in a medical setting.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Good evening, everybody and welcome to this share the pressure session. Share the pressure is um a really exciting project that we are involved with. At the moment, it's funded by the Burdette Trust for Nursing. And the aims of share the pressure are to address the burden of high BP amongst Black African and Caribbean people using a shared decision making tool. It's a partnership by a number of different organizations. So we have the Race Equality Foundation ourselves, Smart Health Solutions, younger Lives and BP. UK. My name is Joanne Horse. I'm the clinical Director of Smart Health Solutions as well as doing a number of other roles. And this particular talk this evening is around using the heart age tools. So it's gonna be a bit of a practical demonstration of what to do and hopefully give you a little bit more information about it to see whether you think it would be something to have a go out and use in your practice. So we're are a team of us delivering this. So from smart health, we who are looking after the educational element of it. Um We have Makayla Nuttall who may be known too many of you. Um She is one of the directors, Smart Health Solutions and one of the founders of Learn with nurses. Um I'm also the clinical director of and we also have our amazing colleague David David Koro, who is a community trainer and educator, who has a real passionflower for this share the pressure project. He's joining us on some of these webinars and you may already have heard him talk about the personal impact that this has had on his on himself and his family. And then of course, this me. So hi, everyone. That's hello. Hello, Zoe. Zoe is one of the lumbar nurse's team. So fantastic to have you with Zoe. Hi, Lisa and hi, Natalie. So you've discovered the chat box. Um If you're new to medal, then I'm gonna give you just a little bit of a heads up on it so well done for getting this far. You've managed to find your way into the session, hopefully in doing so. So you found these couple of little slide e buttons where you can request catch up content. So to be able to see the slides, but actually all of these um four webinars that form the share, the pressure series are being recorded and are available to watch on demand. So if this is the first one you're seeing and you want to see the others, then you can feel free to catch them up on demand or we still have a couple of live events available to book for. Um You'll also get a certificate of attendance if you slide that button across for your all important portfolio revalidation, whatever you need that for. And if you have any problems at all with Medal and accessing the things that you need to do, you'll see there's a little chat box in the bottom right hand corner of your screen. If you click on that, it will take you through to a live chat and are amazing colleagues at Medal. We'll be able to help you with any problems that you may have. So do you feel free to chip in, ask any questions? Put anything you like in the chat, chat to each other? If you get bored? I mean, that will be absolutely fine. Um And I will pop a little feedback form, link into the chat a bit later on so that you can let us know what you thought of this session. And um anything else you want to tell us? So why are we involved in this project? Well, as many of you may well know, ethnicity is a significant risk factor when it comes to cardiovascular disease as a whole. And we know that people of different ethnic backgrounds are affected in different ways. Now, when we're talking about high BP, we know that this disproportionately affects black people of African or Caribbean descent. And unfortunately, in this population, this does lead to a higher incidence of stroke and end stage renal failure. Now, we also know that black people find themselves less likely to access routine screening and health checks and this is particularly the case for men. And even once the diagnosis is made, black people are less likely to have their high BP controlled than their white counterparts. And COVID 19 has just made the situation worse. Really, it wasn't great to begin with, but we've missed out on taking so many BP pressures and seeing so many patient's throughout this time. Whilst services have had to focus on obviously delivering the co response. But also people have been less able and less willing to come out and access these things for a variety of reasons. So there's lots of work to be done here. So what we're doing through share the pressure, we have a new tool that I'm gonna show you in a little while. Actually, it's not a new tool. It's an older tool um which looks at the use of heart age too, support both the communication of risk with people and also to help them in decision making about their treatment and how they manage their high BP. Now, we have been involved in a share the pressure project previously and the use of heart age is evidence based this good research on it, but it's not been tested in this population that we are aiming to reach now. So it the main study took place in Spain, working with Caucasian populations. But we are specifically looking at the black population of South East London for this arm of the project. Now, the learnings from it, we hope we can spread, we hope we'll be able to share what we've done and run this in other areas of the country. This is a pilot scheme that's funded for this particular area, but also for share the pressure to be available for anybody to be able to use. Um We're just trying to test out whether it's helpful and we have every confidence that's going to be helpful, but this is what pilots are all about. So we've been talking to lots of people and our colleagues at the Race Equality Foundation have hosted some focus group where they invited people to come along. They've, you talked to them about BP. We've shared some of the screenshots and some, some of the imagery around, share the pressure because what we've done this time is we have you use that information to try and tailor this to the population that we're trying to reach and just to test out that we are using the right kind of terminology, the right kind of images and you know, really that this is gonna reach out and be relevant to this population that we're trying to reach. So what we heard from the wonderful people that, that were kind enough to participate in our focus groups is that it's really important to be able to take control of your health, your life and any conditions that you may have. And I think it's fair to say that most of us would want to do that. Uh It's important to people to be able to stay young as useful as we can. And we don't really want to start thinking about aging. It's not something that any of us are looking forward to again. I'm sure many of us can relate to this. Now, we've also heard and I supported an event. We ran an event um at the Race Equality Foundation for the 100 Black men of London organization. We had some great people come along to talk about hypertension and to have a look at the share the pressure resources and we were chatting there and in the focus group about how there's a lot of myths around, about high BP, particularly around symptoms. Now, most people that have high BP never have any symptoms, they don't know they have high BP until they get tested. But there are a lot of myths around that you will feel unwell if you have hypertension. So if you feel okay, you're probably all right. People reported that they expected that they would suffer headaches, dizziness, um pains in some cases, but they would know that there was something wrong when we know. Unfortunately, this is generally not the case. People also told us it was really important to them to find out what was available in their local area to support them where they could get their BP checked where they could go for follow ups and where they could get information about organizations and resources that could support them in their local area. They were also keen that anything that they participated in to get some information would remain anonymous and quite understandably not wanting to share personal data. And they also told us that they were keen that any uh information that was offered particularly around diet was looking generally at diet, not just specifically at traditional African and Caribbean foods. Because um many families as they go through the generations of having been uh settled in this country for many, many years, particularly the younger generation are more likely to just be eating all foods. And as we all do sampling the variety of everything that's available to us. So it was important not to focus purely on traditional African and Caribbean foods that may not always be relevant to all of the population. So it's really helpful to have some of that information to be able to tailor what we had to offer within the share, the pressure too. Now, using this tool, which as I say is based on the concept of heart age. And if you're not familiar with heart age, what it really is is another way of expressing cardiovascular risk. So we may be familiar with looking at 10 year risk schools using Q risk or using framing and based tools. But this version of heart age uses exactly the same algorithm, but just presents the information in a different way. So rather than giving our patient's ourselves, the people that we are that are looking at this, rather than giving risk as a risk of having heart attack stroke in the next 10 years or over the course of a lifetime, it expresses that risk in terms of heart age. And so that's really looking at based on your risk factor profile, what it would estimate the age of your heart as being you can then compare this to your chronological age. And hopefully, it will resonate with most people. For example, if you were 48 years old as I am and my heart age based on my risk factor profile came out at 60 thankfully, it doesn't quite yet. Um I would recognize that that maybe not such a great thing. And I might want to start about potentially making some changes to address that risk. Whereas if you told me that my risk of having a high heart attack or a stroke over the next 10 years was 10% that might not be quite so clear to me. So it's another way of helping with communication and the understanding of what somebody's individual risk could mean to them. So this is a publicly accessible website that we're using. So people can go in and use this directly themselves. Um It could also be used with the support of a health care professional. It could be used directly by healthcare professionals. It could also be used in community settings. And we're seeing a lot more commune Nitti case finding types of events happening all over the place, which is fantastic as we share our ambitions around finding high BP and managing high BP across multiple organizations, community groups, faith groups, and everybody, the the whole of the population and organizations that are there to support them to try and share the burden but also to maximize resources and reach as many people as we can. So you can access the share the pressure tool at share the pressure dot com or you can also access it via our website as smart health solutions dot co dot UK, which perhaps you came through to find your way to this webinar today. And I will tell you a little bit about what else is available on the website later on. But you've got three boxes that you can select their. One is the resources for healthcare professionals. So these webinars, some on demand stuff, we have some podcasts and various other things available resources for patient's. And then we also have the link through to the heart age tools. So if I can make the magic happen and stop presenting this and share my screen, I hope I'm going to be able to take us to the live version of heart age, which hopefully you can all see it now. So as you will see, um it's presenting us with the offer of taking control of our BP and staying years younger. So there's a quick two minute assessment that you can take as an individual or with help and um find out how your BP and other risk factors are affecting you and what you could do about it also reinforcing that this is completely anonymous and your results won't be shared with anyone. Now, obviously, we are looking at um aggregated anonymized data across the whole of heart age to be able to evaluate it and uh see how it's working and what sort of results that we are getting for people. But there's nothing personal, um nothing identifiable that's kept on there at all. There's also a bit there for healthcare professionals and the healthcare support tab will take you back to our website and smart health to be able to access more educational materials um on this subject. So if I click into two minute assessment, it's gonna ask me first of all to tell it about me. So um I am for the purposes of doing this, going to um enter as if I were using this with a patient so that I can try and sort of generate something a bit more interesting than if I were doing this is me because surprisingly, I've got a really good BP, really low BP, in fact, and a pretty good cardiovascular risk profile. So, first of all, it's going to ask you if you have ever had heart disease, kidney disease or what diabetes. So, in this case, I'm going to say no. And the patient that I'm gonna be representing here has not had any diagnosis of any of these conditions. Um I'm gonna pick someone, let's go with my age because why not? And I'm going to pick a chat because we know that it's particularly the men that we um often have less engagement with for this kind of thing. And I am going to select a um black African ethnicity, the ethnicity profiles that we use here are the O N S profiles. So there's a number there for people to select from and he's not a smoker. So most simple information first, it's then gonna ask us for a little bit more information about our individual about how tall they are on what their weight is. So I'm gonna pick a fairly, fairly tall fellow here cause why not? So he is 6 ft one, let's make him and then we're gonna make him, what should we do? Feel free to chip in and suggest something that you think I should do. But I'm going to maybe make him 14 stone and no, he doesn't have any family history of angina or heart attack, a premature age. So you'll recognize these if you have done, um, if you've done cardiovascular risk assessment yourself. Okay, Lisa. Thank you for contributing. I'm going to go back and I'm gonna, I'm gonna take up your 86 kg that you've given me. You can see I'm old fashioned using my, um, stones and pounds rather than that. So 13 8. Yeah. So that's, that's not too far off. Okay. So thank you for that. Um, It's then gonna ask about cholesterol and BP. Now, if people don't have that information to hand, what it will do is much like other risk assessment tools will do, it will pick an average level for somebody of your age, sex and ethnicity. Um So if you do know the information, then your heart age is going to be much more accurate. But if you don't know the information, you can still go ahead and do it anyway. So I'm going to say no that I don't actually know off the top of my head. What my cholesterol level is what it will then ask is if you don't know it. Has anyone ever told you? So has a healthcare professional ever told you that you have high cholesterol? So has it been checked in the past? You might not know your number but actually it has been mentioned in the past that your cholesterol is high. I'm going to say actually, no, I'm not aware. I don't think I've ever had it tested. Do you know your BP? Well, yeah, actually I do know my BP because I just recently had that checked, you know, I was down the community center, I went down there for whatever something else. And there was a nice, nice young man, they're checking blood pressures and he checked the BP and actually he did say it was a bit high. So I'm gonna put in a systolic BP of 1 60 and then it's gonna ask where that BP reading was taken and why it's relevant to ask. That is a, so it can look at the numbers because we would expect BP to be lower if you were taking it at home or outside of a medical setting, we expect it to be a little bit higher if it's within a medical setting. So we want to put that into some sort of context, but also that will influence the advice about follow up as well. So we'll say we took it or had it taken at a health event. And no, we are not currently on any BP tablets. So I'm going to ask if a health care professional has ever discussed the option of going on tablets for your BP. So I'm going to say actually, no, I didn't know I had high BP until I went to this event. And no, nobody's ever spoken to me about that. And then it's going to generate a result for me. So our patient's information that we have put in there has generated a heart age of 54 which is six years older than his chronological age of 48. So that would suggest that his risk is increased. What we can do is click on this blue button here, the refresh button and that will give an idea of how many years you could potentially take off your heart age by making some changes to life. So if we click on that, actually, we could take up to seven years off heart age by making lifestyle changes. So it's possible to end up with a heart that's even healthier than would be expected at our age. So that's what that little button there does, which hopefully would start to make somebody think that it might be worth looking into the information it's then gonna give is that that on the, what should I do now that the BP reading you've given us is raised according to NHS guidelines, it's important to get this rechecked at your local GP practice or your local participating pharmacy. So call or drop in within the next couple of weeks and ask for a routine appointment. And we're very clear at this level that it needs to be a routine, that thing that's happening. We don't want to cause any undue alarm and we don't want people um you know, feeling the need to place higher demands on healthcare services to get urgent appointments or anything like that. Because yes, this does need to be followed up within the next couple of weeks, but it's not something that needs to be dealt with tomorrow. So in the meantime, you can click that blue refresh button to see what difference you could make by making lifestyle changes such as losing weight, eating, healthily, exercising more and not smoking. Now, at the bottom, it's going to give our patient our individual a summary of what we know so far. So this is a traffic light coded. So we have the grave for cholesterol because the cholesterol is not known. So it's suggesting that he get his cholesterol tested. So this is something he could mention when he goes to request a routine appointment to follow up on the BP. The BP is in red because it's raised that systolic BP was 100 and 60 in at a health event in a community setting. So we know that that BP reading was um suggestive of of a high BP. But of course, we need to, that's what it was on that day. We need to obviously do further investigation before we can suggest that this chap could have hypertension. We just know that that BP is raised on that occasion. We've got an Amber for our weight because he's a little bit overweight for his size. He's not huge. Um But you know, his his B M I will be slightly raised and we've got a green that he doesn't smoke. So hopefully that is all pretty visual and makes sense too. We'll go into the next bottom, about bottom, bottom, it was at the bottom. Um And this ask some questions to start. This is kind of based on behavioral therapy to start thinking about how motivated people might be to make next step so that we can help, um, provide the right support and the right information that they will find helpful. So some people might do this and think, yeah, I'm not going to do anything else about it. So we're gonna find out we're gonna ask them and we're also gonna use this in our evaluation to, um, how motivated you are to make an appointment for follow up. I might say, well, actually, yeah, now you've told me this, I'm going to go and find out about it. What do I want to do to lose weight? Do I? Am I interested in losing weight and keeping weight down long term? Well, actually, I don't think I really need to lose that weight. I'm actually maybe this is quite a, quite a buff fella that, you know, does plenty of exercise goes to the gym. So, actually, is not interested in losing weight because he wants to keep the bulk, the size that he has. And, you know, hypertension, high BP does happen in people that are otherwise fit and well who are young, who are fit active, going to the gym, very physically active, all of the rest of it. So it doesn't necessarily mean that he is overall and unhealthy chap as such in terms of his lifestyle. I say, yeah, I want to know about eating healthily. Um So we talk about reducing salt that sugar, eating more fruit and veg. So yeah, I'm interested in that. Uh yeah, I'm interested in exercise. Would I be motivated to take medication every day? So this is just thinking about head about what may or may not float this chap's boat as it were at this time. So no, and never want to go onto medication. All of this is helping to generate a personalized result for him. So as with both behavioral change stuff, there's two things that we measure, we've measured people's motivation to do something. We also measure their confidence in doing. So. So we've asked him about his motivation. We're now going to ask him about his confidence. So yeah, he's confident he's going to make an appointment, not going to lose weight. He is confident that he can eat more healthily, really confident that he's going to exercise regularly. But no, not going to be having medication that's not going to happen. So it's then going to generate um some personalized advice for him. Uh We've got a number of boxes here that he can select and choose what's gonna work for him. So talking to your healthcare professional, if we click on that, then it's going to take us through and click us on some patient focused advice. It's gonna suggest some questions that you might want to ask. He might want to ask his health care professional. Um So there's advice there for going to talk to your healthcare professional, his healthcare professional, there is information here on healthy eating and drinking. And again, he can go through. It gives the bare facts about something and then there's the opportunity to go through and click further information to find out about it. And BP UK do a specific leaflet on a traditional African Caribbean diet. But as we said, you know, it's important that all information is available to suit the individual and what their dietary preferences are. There's information there about alcohol as well. Similarly about becoming more active, we then have some area specific resources. So this is of course, South South East London that we're looking at. So at the moment, we've got local support in Lambeth and Bromley that we have got available on here. I think we may still be populating those. Yes, we are still populating those. At the moment. I thought we were information to help around losing weight, information on BP medication, quitting smoking. And then we also have a series of F A Q s available so that people can look through and find out anything that they want to. So that's all the information that's there. We are asking people to also complete a survey to let us know how helpful they found this or otherwise. Now I've probably gone through it pretty slowly because obviously I'm sort of explaining as we go, go along, but it's, it's pretty intuitive with um what you need to do um to take it. So people should be able to fill this in quite easily. People could be directed towards it by healthcare professionals is something that as I said could be done with a healthcare professional in community settings. Um As another tool in the armory to be able to support people and try and reduce this disproportionate burden. If you want to do it again, you can click on the retape button. So I'm now gonna stop share ing that one and come back to my slides. Hopefully, those have come back to you again and there's just a screenshot of share the pressure, the two. So what else we have available for healthcare professionals? We've formed a virtual community of practice so that we have this home that people can go to to find out more about share the pressure and particularly about this disproportionate burden of hypertension in Black African and Caribbean people and what we can try and do to help support them to make changes and reduce their risk. We also have um webinars on lifestyle and we have a webinar on medication to manage BP as well. I think those are all available there now on demand, but we do have a couple more live events to come. We've also recorded some podcasts. So if you're tend to be someone that likes to stick your earphones in while you're cooking dinner or going for a run or walking to work or whatever it may be. We have a couple of podcasts, they're ready. There's another one that needs to go up that follow the similar kind of things as are in these webinars, but in a nice simple, easy to listen format there for anybody who might want to listen to them. And we also have some other resources and we have things on there and we're hoping to increase this that are of particular relevance to Southeast London because obviously that's where our pilot site is. So we're looking to get some local guidance on there. There's some fantastic um BP guides, one for each of the boroughs in Southeast London that have produced, been produced by the Clinical Effectiveness, Southeast London Group. Um And they're so great and easy to follow that. Um You know, I've actually been, I'm not in Southeast London myself, I've been looking at those and been using those um because I find that they're really helpful. So if that's your area, then do have a look. Um If you're not already familiar with those, we've also got links to some publications. There's, there's one already on there that Michaela David and myself have written Tracy from the Race Equality Foundation has also had a publication about share the pressure as well. So there's a wealth of stuff that um people can go on there and access to hopefully be helpful in learning more about this, this really health inequality that is having such a dramatic effect on people that we know about it. We can't let it continue. We have to try and address this and reduce this burden and help our population to live longer and healthier lives because people are being really sick and they're dying early as a result of this. And we know how to find it and we know how to treat it. So we really have to make sure that we're reaching everyone in our population and making particular efforts to reach those people who are so dramatically affected and finding less access to treatment. So what I would ask of you is to give it a go have a look, do your own heart age, see how it works out for you. Knowing your heart age has been proven to be a great motivator to people in their choices around their lifestyle and making a difference to try and reduce their overall cardiovascular risk. It's certainly been proven in a study population that has validated this tool and we're really excited about testing it out with our population in Southeast London and the beauty of it is that it can be used with or without healthcare professionals. So anybody can access this and use this people who will be pointed towards it and give a well. But we know it's just one part of the journey. This is about giving people information and information is power. Information is a tool on which people can make decisions that will be right for them. So this is the information, giving bits the decisions around what changes to be made and what medication to have really have to be led by our patient's. This is about shared decision making, but obviously, we can do everything in our power to support and provide the resources that people need to enable them to make and continue along with their management plan. Whatever that may be, do join us for more sessions or have a look for any that you've missed. Um If there's anything that you would like to feed in to share the pressure, any observations, any information or you want to know more, then you sign up on our community of practice and you'll be getting a little email alert out when we have new resources available. But do reach out to us if this is something that's a particular interest to you or something that you want to share, and we will of course be looking to roll this out in more areas in the future. So if you have an interest in doing this, then again, do reach out to us. Um So that's all I have to um report as it were on this session. Please do feel free to drop any comments, questions or anything into the chat box here. I've just popped in the link to provide the feedback. Do please let us know if you found this useful or not? Thank you to those of you that have already commented Ingrid Saralee. So that's really, really great to know that you've found that helpful Ingrid. Thank you for having a look at the website. Um We're, we're really pleased with how it's coming along and we do think there's some really useful stuff in there. So tell your mates share in your practice areas and um let's get people giving this a whirl and see what we can do to try and support people to reduce this really unfair situation that we're in at the moment. Thank you so much for your time. There's no further questions or comments. I'm going to wish you a good evening. Thank you for joining us. Thank you, Zoe. Give it a whirl. Let me know how you get on and we'll look forward to seeing you on another share, the pressure webinar soon. Thanks very much. Have a wonderful evening. Take care. Bye bye.

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