Overview of Glasgow & Clyde Weight Management Service (GCWMS) Gillian Bryson. Specialist Dietitian/ Clyde team lead

Transcription

1 Overview of Glasgow & Clyde Weight Management Service (GCWMS) Gillian Bryson Specialist Dietitian/ Clyde team lead

2 Main areas requested to cover Referral process What occurs at the service What the patient receives Length of the programme Challenges/ patient s experiences Success stories, success rate How can PN support individual in long-term? Resources for PN and useful websites to pass onto patient or to utilise for yourselves

3 GCWMS Bases Adapted environment >120kg Clyde Mansionhouse Unit 100 Mansionhouse Road Glasgow G41 3DX Sir James Clark Building, Abbeymill Business Centre Paisley

4 GCWMS Aim To establish a weight management pathway of care, from prevention through to the management of morbid obesity, which is evidence based and equitable across NHS GG Board. offer consistent treatment approaches optimise current resources provide a clear referral route ensure the appropriate use of drugs and surgical interventions

5 Whole System Approach Comprehensive service aimed at prevention of overweight to the pharmacological and surgical intervention in severe and complex obesity surgery 3 BMI >35 or > 30 with comorbidities MDT in MHU and Community with community dietitians Training GCWMS 2 BMI > 25 1 BMI Local Authority e.g. Shape Up or Live Active, Waist Winners, Commercial, Voluntary sector Training Primary prevention approaches using population based strategies and resources Community dietitians 5

6 >18 years of age BMI >35 or > with co-morbidities Co-morbidities, Diabetes, CHD, Hypertension, Sleep Apnoea ARI (additional reason for intervention) Awaiting surgery, age 18-25, Iatrogenic weight gain, mobility issues Medical history and medications 6 6

7 Referral to GCWMS Sci Gateway referral (Nov 2008) efficient, timely, quality. GP or Consultant/hospital doctor only (tick box). Do you have arrangements in place within your practice to refer yourselves??

8 GCWMS a Multi disciplinary service Clyde Team Lead Gillian Bryson, Specialist Dietitian Specialist Dietitians Marian Cartlidge, Rhonda Wilkie, Anna Julian Clinical Psychologists Dr Marie Prince/ Dr Ross Shearer Specialist Physiotherapist Andy Harrison Administrators Marion O Byrne Technical Instructors Susan Lewis 8

9 CWMS Pathway GP Referral Opt in Assessment physiotherapy Opt in psychology PHASE 1 Lifestyle programme PHASE 2 Anti obesity Medication Weight loss <5kg Weight loss >5kg 16 weeks (fortnightly) Further Weight loss 12 weeks Low calorie diet (monthly) PHASE 3 Weight loss <5kg Weight loss >5kg Maintenance Programme 12 monthly sessions 9 Bariatric surgery information session** **Pt with BMI > 35 with co morbidities or BMI >40 Discharge level 2 Local Authority e.g. Shape Up or Live Active, GP Commercial, Voluntary sector 9

10 Average Patient journey time May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Date Opt In to Date Assessed AVG in Wks Date Opt In to Date Group Started AVG in Wks Total Journey Date Opt in to Date Group Started AVG in Wks

11 Target 5-10kg maintained over 12 months modest maintainable weight loss 5-10kg weight loss results in many benefits (SIGN 1996, 2010) Significant reduction Mortality Grade B diabetes and cancer related deaths Physical Grade A Reduced back and joint pain, osteoarthritis disability Improved lung function Lipids Grade A total cholesterol, LDL cholesterol, triglycerides and sig increase in HDL Blood pressure Grade B both systolic and diastolic blood pressure Glycaemic Control GradeB and reduced risk/ incidence of diabetes 22

12 Phase 1 Completion and success in GCWMS Aug-Oct Patients Started Patients Completed >5kg loss Patients Started Patients Completed >5kg loss 50 Aug Aug Sept Oct Sept Oct Totals %

13 GCWMS Clinical Results bench marked against Counterweight Counterweight 6 months data *GCWMS Phase 1 data GCWMS Aug, Sept, Oct 2011 Number Mean Age Mean BMI % Diabetes Mean weight Loss kgs % Completer s (1618) % Completer >5kg Counterweight absence of diabetes associated with increased mean weight loss *Evaluation of the first phase of a specialist weight management programme in the UK National Health Service: prospective cohort study; Morrison et.al (2011)

14 Pilot data from GCWMS Patients with type 2 diabetes on insulin (who are less amenable to weight management interventions than those not on insulin) Who completed at least phase 1 of the GCWMS programme Showed a mean weight loss of 6.03% Showed a mean reduction in HbA1c of 0.56% (SD 1.57) over a mean of 11 months

15 MSc student study, preliminary findings Study: 18 month follow up assessing weight maintenance of successful weight loss patients from GCWMS 50% of patients maintained >5kg weight loss. 87% of patients weighed less than initial weight at follow up. Attending maintenance programme was highly significant in successful maintainers.

16 North Lanarkshire Referral rate by CHP for Aug 11 Oct 11 Comparison of Referral rates by CHP Population 0.40% 0.35% 0.30% 0.25% 0.20% 0.15% 0.10% 0.05% 0.00% South Lanarkshire Glasgow North Glasgow East Glasgow West Glasgow South East Renfrewshire Glasgow South... East Dunbartonshire West Dunbartons... East Renfrewshire Inverclyde

17 Assessment & Group venues in Inverclyde Assessments: - Inverclyde Royal Hospital - Greenock Health Centre Groups: - Education Centre, Inverclyde Royal Hospital. Thursday afternoon. - Group Education Room, Port Glasgow Health Centre. Monday afternoon. These venues all available for patients <120kgs

18 Average monthly opt-in for assessments Number of assessments available per month Average monthly opt-in for assessment in 2011 Inverclyde Royal Hospital Greenock Health Centre

19 Phase 1 Lifestyle Intervention Delivered by Specialist Dietitians. 9 sessions, 1.5hrs. Fortnightly. 3 components- Diet, Activity, Behavioural (SIGN 2010).

20 Patient feedback from groups Mr B (63 yr old male) Hypertension, CHD. p1s1 wt= 103.9kgs completed programme = 85.5kgs Mr M (20 yr old male) referred with high anxiety levels and low confidence. p1s1 = 133.1kgs, p1s9=125kgs. working with the group was good; gave me more motivation to lose weight

21 Patient feedback from groups Mrs R (66 yr old female) Hypertension, Type 2 DM, on referral GP had discussed?increasing Gliclazide dose due to HbA1c. - lost 4.5kgs in p1 and has now lost 6.3kgs in p3 of programme. - HbA1c has reduced from 8.4% (on referral to service) to 6.9% at end of phase 1. Gliclazide dose has not been increased.

22 Patient feedback from groups Ms McK (28 yr old female) p1s1 wt= 117.3kgs, p1s9= 110.8kgs. I have been going to the talks in Paisley which I found really helpful.the program is really adaptable, anyone could fit it into their life and there is lots of help & support along the way.

23 Patient feedback from groups Mrs S (49 yr old female) = p1s1=119.8kgs, p1s9 =113.1kgs. great course really changed my attitude towards what I eat information was broken down to an understandable level.

24 Visit the GCWMS website for information about the service and additional support. Ask your clinician for the Patient Area Password, where you can download information such as: Psychology Talk Times Activity Class Times Lifestyle Diaries