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Theme 6: Investment in Prevention (evaluation of targeted prevention of cardiovascular disease in primary care)

Our approach

This theme was concerned with improving access for people at risk of cardiovascular disease. There were two main elements to this work: (1) an evaluation of targeted case finding for cardiovascular disease prevention being implemented in Sandwell and Solihull and (2) an evaluation of an education programme commissioned by Heart of Birmingham PCT and delivered by Health Exchange to help patients with chronic diseases to improve the self-management of their conditions (Chronic Disease Educators Service).

Evaluation of targeted case finding for cardiovascular disease
Service level interventions were put in place in deprived communities in Sandwell and Solihull PCTs. This theme was concerned with ensuring that patient level interventions (of a medical and behavioural nature) of proven effectiveness reached those who most needed them. Those at highest risk have the greatest potential to gain from intervention and are the group in which intervention is most likely to be cost-effective. Untreated individuals at high risk of cardiovascular disease were identified from primary care records and systematically invited for assessment, lifestyle advice and treatment.

The incremental uptake of assessment and treatment was measured by means of a cluster randomised trial. General practices were randomised to earlier or later intervention of targeted assessment, ensuring that no practices were excluded from the intervention. Routine data was used to determine uptake and qualitative evaluation investigated the patient and staff experience of the process.

The likely effectiveness of the interventions was modelled from routine measurements and from the published evidence on effectiveness of similar programmes in order to estimate cost-effectiveness. A programme of qualitative research addressed the facilitators and barriers to successful implementation of preventative health initiatives, through an exploration of the experiences and perspectives of those delivering the services and patients.

Chronic Disease Educator programme

The Chronic Disease Educator programme was evaluated using a mixed methods realist evaluation approach. Results were fed back to the commissioners and service managers. As a development of this work, research was conducted to explore in depth the experience of an ‘at risk’ population in Birmingham, the Sikh population, in terms of their experiences of managing chronic vascular conditions and prevention, to explore ways in which services could be designed to be more culturally appropriate.

Our projects

We were successful in achieving an additional £300k from Cancer Research UK to undertake a study to conduct targeted case finding for people with suspected bowel cancer. This study is known as ColoRectal Early Diagnosis: Information Based Local Evaluation (CREDIBLE).

Additional work was undertaken to analyse a large database of anonymised patient records, known as the THIN database. Researchers analysed how and when preventative treatments are used in the UK in order to identify the extent of unmet need for cardiovascular prevention.

Author(s) Title Journal Publication date
Nirantharakumar, K; Hemming, K; Narendran, P; Marshall, T; Coleman, JJ A prediction model for adverse outcome in hospitalized patients with diabetes Diabetes Care 2013 36:3566-3572 11 September 2013
Wu, J; Zhu, S; Yao, GL; Mohammed, MA; Marshall, T Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study PLoS ONE

8(7): e67611.

26 July 2013
Nirantharakumar, K; Saeed, M; Wilson, I; Marshall, T; Coleman, JJ In-hospital mortality and length of stay in patients with diabetes having foot disease Journal of Diabetes and Its Complications

Volume 27, Issue 5, September–October 2013, Pages 454–458

doi: 10.1016/j.jdiacomp.2013.05.003

15 June 2013
Madigan, CD; Aveyard, P; Jolly, K; Denley, J; Lewis, A; Daley, AJ Regular self-weighing to promote weight maintenance after intentional weight loss: a quasi-randomized controlled trial J Public Health (2013)
doi: 10.1093/pubmed/fdt061
9 June 2013
Mohammed, MA: Marshall, T; Nirantharakumar, K; Stevens, A; Fitzmaurice, D Patterns of warfarin use in subgroups of patients with atrial fibrillation: a cross-sectional analysis of 430 general practices in the United Kingdom PLoS One
doi: 10.1371/journal.pone.0061979
2 May 2013
Theme lead

Prof Tom Marshall

  • Former Sandwell Primary Care Trust
  • Former Solihull Primary Care Trust
  • Former South Birmingham Primary Care Trust
  • Former Heart of Birmingham Primary Care Trust
  • Walsall Healthcare NHS Trust
  • University of Birmingham