how i manage: putting self-care theory into practice/media/confederation/files/public...
TRANSCRIPT
How I manage:Putting self-care theory into practice
Chair: Ruth Poole, Trustee, NHS Confederation
Dr Cees Van Berkel, Director of Innovation, Philips Healthcare
David Horsfield, Digital Care and Innovation Lead, NHS Liverpool CCG
Wayne Farah, Vice-Chair and Non-Executive Director for Patient and Public Engagement, NHS Newham CCG
Dr William Bird, Chief Executive, Intelligent Health
Theme Partner:
Themes:
- Person Held Record
- Assistive Technology
- Predictive Analytics
- ILINKS - Integrated
Records
Enablers:
- Information Governance
- Digital Maturity &
Workforce Development
- Interoperability &
Infrastructure
The Lessons…
Success of digital = people not technologyMove away from evaluation design
to what works in the real world
Analytical tools are key – know your population
Its never right off the shelf – partnership is key
Wayne Farah Vice Chair
Newham CCG
Dr William BirdCEO
Intelligent Health
Newham Community Prescription
&
Desmond’s StoryMy GP told me I was pre-diabetic and gave me advice on changing my life style -exercise all that stuff. Its not easy changing your life so I ignored it. Six months later I was diabetic. Being told
what to do doesn’t mean you can do it. I wish I had practical help to change my life style earlier.
© 2015 Intelligent Health
Sociable Green Valued
Our factory setting is to be in a sociable group, supportive environment and
have a purpose
People Place Purpose
© 2015 Intelligent Health
Chronic Stress
Stress
Hormones
Physical
Inactivity
And other
poor health
behaviours
Chronic Inflammation
Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No 5 2007
© 2015 Intelligent Health
Inflammation: ‘the cause of causes’
Chronic
Inflammation
Starts in children
as young as
6 years old
ArthritisArthritis
CancersCancers
DiabetesDiabetes
ObesityObesity
DementiaDementia
Cardiovascular
disease
Anxiety and
Depression
© 2015 Intelligent Health
Inactivity causes inflammation
1.
Increases
visceral fat
3.
Damages
healthy cells
2.
Reduces anti-
inflammatories
© 2015 Intelligent Health
Inactivity: trilogy of inflammation
1.
Increases
visceral fat
3.
Damages
healthy cells
2.
Reduces anti-
inflammatories
© 2015 Intelligent Health
Reducing inflammation – fat
Visceral fat = 0.5 L Visceral fat = 1.1 L
Visceral fat = 1.3 L Visceral fat = 1.7 L
Visceral fat = 4.3 LVisceral fat = 4.2 LVisceral fat = 1.8 L
Visceral fat = 1.2 L
Variation in visceral fat
content in men with the
same waist circumference
© 2015 Intelligent Health
Visceral fat reduction with exercise
–25
–20
–15
–10
–5
0
Lean Obese Type 2 Diabetes
Subcutaneous Fat Visceral Fat
Lee S et al. J Appl Physiol 2005;99:1220-1225
Fat loss after 13 weeks of walking 60 mins a day and no weight loss
% Loss of Fat
© 2015 Intelligent Health
Inactivity: trilogy of inflammation
1.
Increases
visceral fat
3.
Damages
healthy cells
2.
Reduces anti-
inflammatories
© 2015 Intelligent Health
Reducing inflammation – muscles
Contracting
muscles
release powerful
anti-inflammatories
called Myokines
These
Myokines
Circulate
around the
whole body
calming every
cell
© 2015 Intelligent Health
Inactivity: trilogy of inflammation
1.
Increases
visceral fat
3.
Damages
healthy cells
2.
Reduces anti-
inflammatories
© 2015 Intelligent Health
Chromosomes
keep dividing
Immune
system is
switched off
until needed
Mitochondria,
healthy
and active.
Providing lots
of energy
Inside a healthy cell
© 2015 Intelligent Health
‘The mitochondria is like a dynamo,it has to keep moving ...
... and in the body they
weigh as much as a car battery’
Prof Mike Murphy,
MRC Mitochondrial Biology Unit Cambridge University
© 2015 Intelligent Health
Sedentary, high fat diet and stress
Mitochondria
Anti-
OxidantsReactive
Oxidative
Species
Mitochondrial DNA
Oxidative Phosphorylation
© 2015 Intelligent Health
Physically active, low fat and not stressed
Mitochondria
Oxidative Phosphorylation
Reactive
Oxidative
Species
Mitochondrial DNA
Anti-
Oxidants
© 2015 Intelligent Health
Telomeres get shorter
Epel, Elissa, et al. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres.
Annals of the New York Academy of Sciences 1172.1 (2009): 34-53
© 2015 Intelligent Health
Senescence: the end of the cell
Hezel, Aram F., Nabeel Bardeesy and
Richard S. Maser. ‘Telomere induced
senescence: end game signaling.’ Current
molecular medicine 5.2 (2005): 145-152.
© 2015 Intelligent Health
Chronic Stress
Stress
Hormones
Physical
Inactivity
And other
poor health
behaviours
leads to inflammationMitochondrial damage and telomere shortening
Depression
Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No 5 2007
Cancers Diabetes DementiaCardiovascular
Determinant
Effectors
Mechanisms
Outcomes
ModeratorResilience to Stressors
Chronic Stress Poor Health Behaviours
Mitochondrial Damage, Telomere Shortening, Chronic Inflammation
CVD Diabetes Cancer Depression
NCP Model of HealthPeople Purpose
Combat ill health by giving GP’s prescribing solutions that address the social determinants of health, by building a community infrastructure that connects patients to the resources they need to engage in activities that promote health, wellbeing, social inclusion and resilience
COMMUNITY PRESCRIPTION
Maria: I’ve lost 3 kgs, I don’t see my GP so much, and my husband said I’m looking great.”
Fazia: “I’ve made a lot of friends and I feel far more positive about myself.”
Patient Voice
NCP pilot in a Nutshell
• QD scores > 15
• HbA1C 42-48 mmol (6-6.5%)
• IGT 7.8 - 11 mmol
• Diet controlled diabetes or on Metformin
• Unless unstable Angina, BP 180/110
• 1-3 sessions physical activity 12 weeks
Wellbeing Score
49
50
51
52
53
54
55
56
57
58
Change in Wellbeing before and after NCP
Before After
p=<0.0004
(WEMWBS)
Physical Activity Before and After NCP(MET Minutes/week)
0
100
200
300
400
500
600
700
800
900
Physical Activity
Before After
p=<0.0008
% Achieving 150 mins moderate activity per week
0
5
10
15
20
25
30
35
40
45
Physical Activity
Before After
p=<0.0004
NCP Minutes of Sitting(Before and after)
0
20
40
60
80
100
120
140
160
180
200
SittingBefore After
p=<0.0018
Life Style AdvisorMotivational Interview
Assessment &Aspirations
Refer and Dispense
Support &Evaluate
© 2016 Intelligent Health
How does it work in Newham?
• Diabetes Prevention Programme (DPP)
Community Prescription (NCP) Beat the Street
At Risk of
CVD
(Q risk
>20% plus
a BMI >27)
Gestational
Diabetes
DPP or NCP
Pre-Diabetes
IGT or IFG
Or HbA1C 42-
47mmol plus
BMI > 27
All other long term
conditions including
diabetes
© 2016 Intelligent Health
Beat the Street East London (45k participants)
Let’s
remove
boundaries
and turn a whole
borough into a
Game!