HEAL Protocol for GPs and Practice Nurses

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Morris Tucker
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1 HEAL Protocol for GPs and Practice Nurses Exercise Pathway Co-ordinator Sport & Active Leisure West Offices Station Rise York YO1 6GA Telephone: P a g e

2 Contents Contents...2 Routes into HEAL...3 Recommendation versus Referral...4 Recommendation scheme...4 Referral scheme...5 Inclusion criteria...6 Exclusion criteria...7 Eligibility...7 Referral process...8 Initial consultation...9 Exercise opportunities...10 Monitoring adherence...10 Programme review...10 Exit strategy...10 Follow up...11 Medical legal responsibility...11 Appendix 1 Exercise Referral transfer form Appendix 2 GP Practice sign up form 2 P a g e

3 Routes into HEAL The scheme enables GPs and Practice Nurses to either recommend patients to various programmes of physical activity accessible through the HEAL programme, or to refer into the HEAL Exercise Referral scheme. The Exercise Referral scheme uses specifically trained instructors and is in line with nationally agreed professional and operational standards for Exercise Referral. Patient identified with a need to be more physically active Patient is motivated to increase activity levels and no concerns about ability to exercise safely Patient requires support with motivation and/or additional guidance to exercise safely due to a medical condition Recommendation Referral General recommendation to increase activity levels. Complete webform to allow HEAL team to contact patient Complete and submit HEAL transfer form to HEAL coordinator / administrator 3 P a g e

4 Recommendation versus Referral There is a clear distinction between a recommendation for an individual to be more physically active and an individual being referred for a programme of physical activity. Is the health professional simply recommending more physical activity or referring the patient for a specific course of action? (NQAF 2001) Recommendation Scheme A general recommendation to increase physical activity levels in order to gain health benefits may be all that is required, if you consider the patient has reasonable motivation and resources to safely increase their physical activity levels. Within HEAL we can provide patients with various opportunities to engage in physical activity. We can help patients to access various opportunities across the city to be physically active. Walking groups Cycle training and organised rides Volunteering and gardening projects Return to swim sessions Classes, including Zumba, Pilates, Tai Chi Sports including return to tennis and badminton. Contact with local sports groups On-line form can be completed to enable us to contact patient with details of activities that appeal to them. m 4 P a g e

5 Health professionals who only intend to recommend patients to general physical activity activities through the HEAL programme are able to do so without registering and do not need to complete transfer forms. Instructors, volunteer leaders and coaches on the recommendation do not hold specific qualifications in working with clients with medical conditions. Patients requiring assistance with the appropriate type and intensity of exercise, as well as specific guidance on exercise considerations due to their medical condition, should be initially referred. GPs and Practice Nurses can sign up for the Exercise Referral scheme by initially completing a GP Practice sign up form, and then completing a transfer form for each patient to be referred into the scheme. Copies of both these forms are in the appendix. Hard copies or electronic copies of these forms are available. Referral Scheme The referral of a patient by a health professional to a facility (public or privately operated, or individual physical activity referral instructor) for the purpose of providing a physical activity programme as part of the management of people with (i) stable, or significant limitations related to chronic disease, or disability and / or (ii) one or more significant cardiovascular disease risk factors (Professional and Operational Standards for Exercise Referral 2011). A referral may be the most appropriate course of action when the patient is likely to need help with motivation, programming, supervision, monitoring, and / or choice of duration, frequency, intensity and type of physical activity to attain specific health outcomes. Inclusion criteria Exercise referral instructors are able to support patients with the following medical conditions: 5 P a g e

6 cardiovascular disease risk factors including hypertension and hypercholesterolemia respiratory conditions - COPD and asthma musculoskeletal conditions - joint replacement, simple non-mechanical low back pain, rheumatoid arthritis, osteoarthritis, osteoporosis mental health mild to moderate depression, general anxiety, stress metabolic conditions - Type 1 diabetes, Type 2 diabetes, obesity There are also specialist schemes through HEAL for phase 4 cardiac rehabilitation neurological conditions (multiple sclerosis and Parkinson s disease) cancer rehabilitation and post treatment The above conditions are ones for which there is a strong evidence base for a specific exercise intervention to help manage or improve either the pathogenesis or symptoms of the condition. Whilst there may be people with other medical conditions who would benefit from exercise, Exercise Referral instructors are qualified and able to support clients with the above conditions. Specialist higher level qualifications are held by instructors working within the specialist schemes mentioned above. Exclusion criteria Patients will not be eligible for the HEAL exercise referral scheme if they have: Resting heart rate > 100 bpm Systolic blood pressure > 180mmHg or Diastolic blood pressure>100mmhg Recent electrocardiogram changes suggesting recent myocardial infarction Febrile illness 6 P a g e

7 Significant drop in blood pressure during exercise Pain, dizziness or excessive breathlessness on exertion Uncontrolled arrhythmia, hypertension and / or diabetes Unstable angina Acute aortic dissection Acute mycocarditis or pericarditis Acute pulmonary embolus or pulmonary infarction Suspected or known dissecting aneurysm Acute infections Uncontrolled visual or vestibular disturbances Recent injurious fall without medical assessment Eligibility To be eligible for acceptance on the scheme patients should: be currently physically inactive or have low levels of physical activity have one or more medical conditions covered with the inclusion criteria of the scheme and no conditions or contraindications that would exclude them from the scheme (see exclusion criteria above) 7 P a g e

8 Referral Process Health professional: Identifies patients that are inactive and have medical conditions covered by the scheme Ensures patient agrees to the referral Completes transfer form and informed consent (including all medical information) HEAL coordinator / admin: Receives referral and checks inclusion / exclusion criteria met and relevant medical information received HEAL coordinator / instructor: Meets with client, conducts motivational interview, gathers information, risk stratifies, aids client to set goals, identifies barriers, stage of change, health behaviours and refers to other where necessary (e.g. smoking cessation services) HEAL instructor: Prepares and delivers exercise programme for the client Supports client and review programme Modifies, adapts and progresses exercise plan Monitors intensity and exercise response HEAL coordinator / admin: Collates data for reports, provides feedback to referrer as to progress of client 8 P a g e

9 Initial consultation An initial consultation is carried out by an Exercise Referral qualified instructor. The purpose of the initial consultation is to: explain and discuss the HEAL programme and referral process confirm clients consent establish goals and develop a safe and effective exercise programme identify barriers and motivators review health and medical history and implications of medications on exercise and any side effects outline the purpose of assessments and the exercise programme and risks and benefits explain responsibilities of the patient Exercise opportunities Within the scheme there are opportunities for patients to be referred into gym based programmes. This is currently available at Energise, Cornlands Road, Acomb. We are currently working to increase provision at other gyms across the city. There is also the opportunity for patients to attend condition specific classes. At time of writing the following classes are available: Neurological Pilates (MS / Parkinsons) Pilates for Rheumatoid Arthritis Circuits for Musculoskeletal conditions Nordic Walking for Musculoskeletal conditions COPD Circuits We are adding further classes on a regular basis so please contact us for details of additional classes or if you have any suggestions for future types of activity. 9 P a g e

10 Monitoring adherence Patients are monitored throughout the period of referral. Adherence is monitored and any non-attendance followed up. Various techniques are used to identify potential barriers and to motivate patients to continue to be physically active. Programme review Programme is reviewed continuously throughout the 10 weeks by the qualified exercise referral instructor and overseen by the exercise referral coordinator. Exit strategy All programmes are designed to encourage participants to increase activity levels on their own outside sessions, and to continue to be physically active after the initial 10 weeks. At the end of the 10 week referral period, an exit interview is undertaken with the patient by the exercise referral instructor / coordinator. This is to ensure that the patient is aware of the various options available to them to continue to be active and to enable us to receive feedback on how well the scheme is meeting the needs of the patients. An important part of the initial consultation is to understand a client s aims and goals. The exercise programme is designed to assist the client not just in medical management goals, but also to enable the clients to achieve other goals or aims that are indentified as important for the client s motivation to continue to exercise on a regular basis. The gyms used for exercise referral allow participants to take out memberships at discounted rates on completion of the referral period. Most of the classes allow participants to keep attending on an ongoing basis. 10 P a g e

11 Follow up Patients who have completed the 10 week exercise referral programme are contacted 6 months and 12 months after completion date to evaluate how effective the scheme is in increasing physical activity levels over the longer term. Medical legal responsibility Clinical responsibility remains with the health professional. Responsibility for safe and effective management, design and delivery of the exercise programme rests with the exercise professional. There must be a meaningful transfer of relevant information to the exercise professional. Responsibility to do this remains with the referrer who must make a professional judgement as to what information must be disclosed to the exercise professional to enable him or her to tailor a safe and effective exercise programme that meets the need of the client. Responsibility for pre-exercise assessment, and reference back to the referrer, remains with the exercise professional. Responsibility for consenting to take part in the exercise programme, and adhering to its design and guidance, remains with the participant (or consenting guardian or carer). 11 P a g e

Oldham Exercise Referral Scheme

OLDHAM COMMUNITY LEISURE Oldham Exercise Referral Scheme April 2015 Exercise Referral Scheme April 2015 From April 2015 Oldham Community will be changing the format of delivery of the Exercise Referral