liver health in portsmouth a health needs assessment dr samantha taplin st2 public health registrar...
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Liver health in Portsmouth
A Health Needs Assessment
Dr Samantha TaplinST2 Public Health Registrar
16th June 2015
Why look at liver health?• Liver disease is an exception to the improvements seen in health
& life expectancy for chronic diseases in the last 30 years
• Mortality rates have increased by 400% since 1970
• Liver disease is the 3rd commonest cause of premature death in the UK
Portsmouth Liver HNA
Portsmouth Liver HNA
Portsmouth Liver HNA
Methodology
Define population and aims
Who needs to be involved
ResourcesRisk identification
Population profilingGathering data
Perceptions of needsIdentifying and
assessing health determinant factors
Choose health conditions and
determinant factors with most
significance and severity
Identify effective and acceptable
interventions and actions
Clarify aims of intervention
Action planningMonitor and
evaluation strategyRisk management
strategy
Learning from the project
Measure the impactChoose next priority
Step 1Getting started
Step 2Identify health priorities
Step 3Assess health priority for action
Step 4Planning for change
Step 5Moving on /review
Step 1. Aims & Objectives….
To reduce the burden of liver disease within the Portsmouth population and on secondary care services through identification of potential upstream interventions
Objectives1.To map the distribution and prevalence of liver disease from different causes in the population of Portsmouth City 2.To map current health service provision for liver disease from multiple aetiologies3.To identify specific population needs by data collection methods including; corporate views, epidemiological and comparative data4.To quantify the costs and burden of liver disease in the current healthcare system5.To identify methods for optimising care pathways for liver disease patients6.To identify potential methods for improving upstream prevention of severe disease in the Portsmouth population7.Make evidence based recommendations to improve current health care provision for liver patients
Portsmouth Liver HNA
Portsmouth Liver HNA
Scope of report
-Liver services and related prevention methods in Portsmouth city
Population:-Portsmouth Residents (205,055)-Adults aged >18 years
Liver Disease
Fatty Liver
Viral Hepatitis
Alcohol
“Other”
Healthy weight
lead PCC
Weight management
Dietetics
Health ChecksGPs
Commissioner
s
PH intelligence
GPs
Drug misuse
Specialists
Homelessne
ss
BME
Community groups
Hep C peer
support
Specialist Nurses
Consultant Specialists
Patient representation
Health Watch
Alcohol Specialist
Nursing Service
Alcohol Strategy Co-ordinator
Commissioner
PH intelligence
PH intelligence
Mental HealthMental
Health
Mental Health
Mental Health Portsmouth Liver HNA
Stakeholder Analysis
Portsmouth Liver HNA
Step 2
•Population profiling•Gathering data•Perceptions of needs•Identifying and assessing health determinant factors
Qualitative data Epidemiological data (published & bespoke) Comparative
Sources of Quantitative data•GBD•Cancer Research UK•Health & Social Care Information Centre Statistics on Obesity•PHE liver profiles•Public Health Intelligence team, Portsmouth JSNA publications on Mortality from Chronic liver disease & healthy weight data•QOF data from PHE General Practice Profiles•Adult end of life care strategy; Portsmouth & SE Hampshire CCG•Royal Free Hospital overview of activity on liver transplant•Hospital episode statistics- PHE bespoke data request •Hospital Episode Statistics including outpatients & cost data•Discussion with stakeholders•Discussion with PHE
Portsmouth Liver HNA
Public Health Outcomes FrameworkHealth Care Public Health and Preventing Premature Mortality
Portsmouth Liver HNA
PHE Liver Profiles
SE region
Portsmouth Liver HNA
Portsmouth Liver HNA
Portsmouth Liver HNA
Qualitative data
Semi-structured in-depth interviews with 8 key stakeholders
Reviewed whole system from prevention to end of life care
Framework approach to analysis
Aimed to • Identify key priority areas• Map health services• Identify gaps in current services
PreventionLifestyle
MotivationPerson-centred approach
Knowledge
Early identificationScreening
Fatty liver risk overlapHigh risk ethnic minority groups
Drop-in style clinics
Patient engagement & self-management
Awareness raisingLifestyle & resilience
Screening opportunities for HCV & HBV
Primary CarePotential opportunities &
challenges; attitudes, diagnostic options, capacity, pathways
Community Support Lifestyle change
ASNSRehab Healthcare professionals
educationSocial support with integrated
wellbeing approach
Specialist CareImproved care through Specialist care
availabilityImproved access to HCV treatment
Space challenges for teams in hospital
Service mapping
Portsmouth Liver HNA
Portsmouth Hospital TrustHepatology department- Hepatology Consultants
-Specialist Hepatology Nursing Team
Alcohol
Liver Disease
Fatty Liver Disease
Food Review
Green grid infrastructur
e
Sports Strategy
Integrated Wellbeing
ServiceHealth Checks
Viral Hepatitis (B & C)
Recovery Hub
Public Health Healthy Weight
Strategy
Nutrition & Dietetics (Tier
3 weight management)
Hepatitis C peer
support
Public Health, Health
ProtectionAlcohol Specialist
Nursing Service (ASNS)
Harm reduction strategies for
people who use intravenous
drugs
Specialist substance
misuse services
Mental Health
Services
Safer Portsmouth Partnership
Primary Care
Needle exchange
Portsmouth CCG
Portsmouth Liver HNA
1.Liver Health steering group chaired by Richard Aspinall (lead Hepatology Consultant) should continue to ensure co-ordinated action across three main work streams (alcohol, obesity, hepatitis B & C)
- The Liver Health steering group should continue to meet on a regular basis to develop broad
strategy across local partnerships Develop Health Checks pathway to include opportunistic
screening and advice for fatty liver disease and HCV
- Continue to develop and strengthen links with the CCG to ensure the delivery of effective and
efficient systems to reduce Liver Disease and its associated inequalities
Portsmouth Liver HNA
2. Build on current viral hepatitis plan to develop a robust Hepatitis B and C strategy and action plan for Portsmouth
-Build on current viral hepatitis plan to strengthen early identification
-Operational delivery networks with Southampton, Bournemouth & Portsmouth to deliver Hep c
treatment across Wessex (more screening, more diagnosis, more treatment)
3. Continue to monitor and evaluate improvements in lifestyle related Liver Disease through the implementation and adjustment of the new integrated wellbeing service
-Link and evaluate integrated wellbeing service in relation to liver disease outcomes for long term
monitoring and evaluation
Portsmouth Liver HNA
4. Raise awareness of Liver Disease in professionals and the public to promote informed lifestyle choices
- Improve education around the impact of obesity, and alcohol use and their combined impact
on likely mortality from liver disease to improve resident awareness and promote healthier
choices
Portsmouth Liver HNA
Portsmouth Liver HNARecommendations for researchUtilise the full CSU data set to further explore and identify areas for localities work in Portsmouth
Use Hampshire Health Records to more effectively map alcohol use and obesity impact on secondary care use
Develop and continue to review evidence for robust methods of identification of liver fibrosis in the community
Strengthen epidemiological data and coding for weight and obesity quantification
Identify robust cost data for liver disease when available nationally. Continue to liaise with PHE and CSU for this information
Portsmouth Liver HNA
Acknowledgements
