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Cardiovascular Disease Prevention – Community Blood Pressure Testing Service

The project has directly benefited from the input of our local BAME communities and trained BP Volunteers.  Their opinions have led to:

  • More targeted advertising of our BP testing events
  • Increased attendance at the events.
  • Improved quality of information, provided in languages that match local need.
  • Tailored training, that takes account of cultural and religious needs and preferences

Background

Cardiovascular disease (CVD) is a term that describes a family of diseases with a common set of risk factors and that result from atherosclerosis (furring or stiffening of artery walls), particularly coronary heart disease, stroke and peripheral arterial disease.

CVD affects around seven million people in the UK and is a significant cause of disability and death, affecting individuals, families and communities. CVD is responsible for one in four premature deaths in the UK.   CVD is the second leading cause of death in Gloucestershire.  Hypertension (high blood pressure) is the largest single modifiable risk factor for CVD and related disability. It is implicated in half of all strokes and heart attacks. There is robust evidence that action to lower blood pressure does reduce the risk to health.

In September 2017, Public Health England (PHE) and NHS England (NHSE) wrote to Gloucestershire Sustainability and Transformation Partnership (STP) to draw attention to the local prevention opportunity. They estimated that up to 110 heart attacks and 160 strokes could be averted over three years by optimising treatment in diagnosed and undiagnosed hypertension.

NHS Gloucestershire CCG was successful in securing funding of £100k from the British Heart Foundation (BHF) to ‘improve the detection and management of Hypertension’.

Aim of the project

‘To increase: awareness of High Blood Pressure (BP) and other risk factors for CVD and to increase the detection of people with High BP.

To provide patients with information and education on; healthy lifestyles, statins and services to support them.’

The project aimed to target areas of higher deprivation and areas of Black, Asian and Minority Ethnic (BAME) communities as research shows that these areas have a higher rate of hypertension. The Kings Fund ‘people from the most deprived areas in England are 30% more likely than the least deprived to have high blood pressure’.

Gloucester City is an area of deprivation and it also has the highest population of BAME communities in the county.  The project therefore aimed to concentrate its BP Testing Service in this area.   However there would be a wider campaign of raising public awareness of blood pressure testing.

Objectives of project

The project has:

  • Trained non-clinical members of the community to take BP readings and signpost e.g. volunteers, workplace ‘health’ leads, local community groups
  • Enabled Community BP Testers to sign post to Community Pharmacists so that they can set up BP Home Monitoring if needed.
  • Resulted in a series of BP testing events across Gloucestershire in a wide variety of venues including workplaces, community events, faith centres, and using the NHS Gloucestershire CCG Information Bus.
  • Enabled community pharmacies to also provide opportunistic blood pressure checks
  • Developed a local communication campaign to promote public awareness of blood pressure and the opportunities for testing and self-testing
  • Targeted Gloucester City residents and the BAME communities
  • Produced patient information in a variety of languages

Planned outcomes of project

The longer term outcomes of the project are to:

  • Reduce premature death from Cardiovascular disease
  • Reduce incidence of Hypertension by providing Public Awareness and therefore aiming to ensure that self-management and self-testing of BP become routine practice
  • Improve our detection rates of Hypertension to above the national average.
  • Support more people to self-manage and understand their Blood Pressure readings and how to reduce their BP if needed

How we engaged local communities and health care professionals in the project

In developing the initial BHF bid, we wanted to gather the views of the local community and healthcare professionals to inform the kind of service we could develop.  We carried out Face-to-Face Patient surveys in GP Practices and gathered feedback from the Gloucester Locality Meetings and via an on-line survey for healthcare professionals.

We held a workshop with key stakeholders to gather wider views on how to improve detection and management of hypertension.  Attendees included – Patient Representation, local health care professionals, Public Health England, British Heart Foundation, Local Pharmaceutical Committee, Gloucestershire County Council, commissioners.

A Hypertension audit was undertaken in primary care to understand prescribing and whether patients were on any, or the correct dosage of, medication.  One of the findings was that only 50% of patients were being treated to the recommended targets.  Detailed reports were shared with practices, to enable them to review patients medication accordingly, improving the management of hypertension.  A new Hypertension pathway was also developed with local health professionals, including GPs.

Training Community BP Testers

Work began with the leads of the Friendship Café a local BAME community venue and café in Gloucester and with the Councils Community Development Support Team Manager.   We worked with other individuals from the local community, inviting them to come along to talk to us about our proposed Blood Pressure Testing training and shape the programme.  We were mindful of mixing women and men, and ensuring we held the events at a good time (we had to be mindful of Ramadan as this could affect numbers attending).

Attendees helped us produce patient information leaflets about Hypertension in several different languages.  These have been distributed to all practices in Gloucestershire as well as the community BP Testers.  The Project Manager also attended events held at the Friendship Café to encourage people to become Community BP Testers.

The first Community BP Training event was held in the community, with attendees from a wide range of groups:  Friendship Café, Gloucestershire Chinese Women’s Guild, St Ann Society of Gloucester Church, Ebony Community Carers, Al Ashraf Secondary School, Redeemed Christian Church of God, Gloucestershire Police, Barton and Tredworth Memory café.

We also held workplace Blood Pressure Training Events for businesses, which included –

  • Stagecoach Gloucester
  • EDF Energy
  • Gloucester Hair Salon
  • Lanes Health
  • NHS Gloucestershire CCG staff
  • Community Pharmacists/Pharmacy Assistants

Community BP Testers

Community BP Testers have been attending local events and community meetings, in addition to using the NHS Information Bus to provide BP testing at wider events such as Barton and Tredworth Cultural Fayre and Gloucester Pride.

We have recently held a Coffee and Chat morning for the current Community BP Testers to be able to feedback how things are going and provide them with a refresher.

One Volunteer Community BP Tester said:

‘I really enjoy being a BP tester. 2/3 years ago, my high BP was picked up via a healthy living sessions I was attending. My GP explained that if I didn’t start taking the tablets I may have a stroke or a heart attack. It did rather shock me as I was a Social Care Assessor and have seen several clients who had survived heart attack and stroke and living with their disabilities.  I am now on medication but I am also exercising regularly.

This is the reason why I volunteer to be a BP tester and I share my own journey with those I advise to see the pharmacists for a re-test or to go to the GP.  I do enjoy the opportunities to meet, chat and help so many people.’

Next steps

The project has trained over 40 members of the public and over 20 pharmacies, resulting in over 500 additional BP tests.  The majority of people tested have said they would not have thought of getting their Blood Pressure checked.  The Community BP Testing service data shows that around 35% of people tested have been detected with high blood pressure and referred for further testing or treatment.

The project has directly benefited from the input of our local BAME communities and trained BP Volunteers.  Their opinions have led to:

  • More targeted advertising of our BP testing events
  • Increased attendance at the events.
  • Improved quality of information, provided in languages that match local need.
  • Tailored training, that takes account of cultural and religious needs and preferences

Project Manager, Gina Mann, said: “Overall working with the Friendship Café has made such a positive impact on our project and its success.  We are hoping to be doing even more with our local communities in the following year!”

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