NICE offer to STPs: CVD prevention Zoe Girdis Regional Technical Adviser South of England and Channel Islands
NICE support for STPs Based on the best available evidence of what works and is costeffective, NICE resources can inform the development and implementation of STP plans to: improve quality and safety by supporting standardisation to evidence-based best practice for your key clinical priorities improve productivity prevent ill health engage patients and communities drive and measure quality improvement 2
Local support offer Advice How NICE guidance, advice and quality standards can help to address local priorities Signpost available metrics to support local evaluation Which NICE resources can support community engagement Support NICE quality standards to embed good practice Shared learning and local education Connecting stakeholders to other teams and specialist support at NICE with other organisations and networks working in areas of shared interest 3
NICE regional and local presence Field Team NICE Fellows and Scholars Regional Technical Advisers (Medicines and Technologies) Associate/affiliate networks (Medicines and Technologies) 4
NICE Field Team and Technical Advisers South Chris Connell Associate Director chris.connell@nice.org.uk + 2 Implementation Facilitators Zoe Girdis Regional Technical Adviser zoe.girdis@nice.org.uk 5
NICE CVD prevention resources 6
How can NICE help you? NICE guidance NICE pathways Medicines advice Evidence summaries, key therapeutic topics NICE evidence search BNF, Clinical Knowledge Summaries Keeping up to date with news Engaging with NICE NICE medicines & prescribing associate programme 7
An overview of NICE Evidence-based products: Guidance Quality standards Evidence summaries Evidence alerts Accredited evidence Prescribing advice Indicator sets Dissemination and adoption support: NICE Evidence Services NICE website Pathways Apps E-alerts Implementation tools Audiences: NHS Patients and the public Public health Local government Social care Commissioners 8
NICE guidance responsibilities for health professionals Professionals and practitioners are expected to take NICE guidance fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Guidelines not tramlines 9
Evidence into practice Maskrey N, 2014 Research National guidance RNLI Local implementation Care of Individual people 10
Patient-centred care Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England all NICE guidance is written to reflect these Treatment and care should take into account individual needs and preferences Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals Expertise, experience, skills and judgement Best available evidence Patient s needs, values and preferences 11
Types of guidance from NICE www.nice.org.uk/guidance Guidelines: Clinical Public health Social care Medicines practice Safe staffing Cancer service Guidance: Technology appraisals Diagnostics Interventional procedures Medical technologies Highly specialised technologies Quality standards 12
NICE Pathways http://pathways.nice.org.uk Bring together related guidance, between and within topics Link other products Quality Standards, implementation support tools etc. Provide a useful format network of recommendations Improve digital formatting for easier access Easier, quicker access to the evidence 13
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Quality Standards 15
Typically 6 8 statements Include measures to help inform local quality improvement work Define priority areas for quality improvement 16
Medicines advice https://www.nice.org.uk/guidance 17
NICE evidence summaries https://www.nice.org.uk/about/nice-communities/medicines-and-prescribing#more-evidence-summaries Summaries of the best available evidence to inform local NHS planning and decision-making, for selected new medicines, off-label use of licensed medicines and unlicensed medicines Summary of published evidence (critically appraised) but NOT formal NICE guidance Topics are selected in collaboration with the NICE topic selection process, with advice from the NICE medicines and prescribing associate network and partner organisations 18
Key NICE guidelines and QS: CVD Prevention (1) Topic QS Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease (CG172, November 2013) Cardiovascular disease: risk assessment and reduction, including lipid modification (CG181, September 2016) Peripheral arterial disease: diagnosis and management (CG147, August 2012) Cardiovascular disease prevention (PH25, June 2010) Cardiovascular disease: identifying and supporting people most at risk of dying early (PH15, September 2008) Hypertension in adults: diagnosis and management (CG127, November 2016) Familial hypercholesterolaemia: identification and management (CG71, July 2016) Atrial fibrillation: management (CG180, August 2014) Type 2 diabetes in adults: Management (NG28, May 2017) Sept 2015 Published Published June 2015 Published Published Published Published 19
Key NICE guidelines and QS: CVD Prevention (2) Topic Behaviour change: general approaches (PH6, October 2007) Behaviour change: individual approaches (PH49, January 2014) QS Community engagement: Improving health and wellbeing (NG44, March 2016) Physical activity: brief advice for adults in primary care (PH44, May 2013) Published Published Physical activity: exercise referral schemes (PH54, September 2014 Smoking: preventing uptake in children and young people (PH14, November 2014) Smoking: harm reduction (PH45, July 2013) Smoking: Brief interventions and referrals (PH1, March 2006) Stop smoking services (PH10, November 2013) Published Published Published Published 20
Key NICE guidelines and QS: Obesity Topic Preventing excess weight gain (NG7, March 2015) QS BMI: preventing ill health and premature death in black, Asian and other minority ethnic groups (PH46,July 2013) Obesity: working with local communities (PH42, June 2017 2012) Obesity: Prevention (adults and children) (CG43March 2015) Maternal and child nutrition (PH11, November 2014) Adults Children Published Weight management before, during and after pregnancy (PH27, July 2010) Weight management: lifestyle services for overweight or obese children and young people (October 2013) Weight management: lifestyle services for overweight or obese adults (PH53, May 2014) Obesity: Identification, assessment and management (CG189, November 2014) Published Published Published 21
NICE Indicator menu 22
NICE Return on investment tools https://www.nice.org.uk/about/what-we-do/into-practice/return-on-investment-tools Key features: Model the effects of single, or multiple, interventions on at-risk population groups Estimate the overall costs against the value of non-health benefits as well as health and wellbeing improvements Mix and match interventions to see which package provides the best outcome Identify cost savings or determine if the additional benefits are worth the extra costs Customise the tools to include data and interventions specific to your local area Use the results to help support your business cases 23
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Tools for shared decision making www.nice.org.uk/sdm Conversation between those delivering care and those receiving care Shared decision making puts people at the centre of decisions about their own treatment and care by: exploring care or treatment options and their risks and benefits discussing choices available reaching a decision about care or treatment, together with their health and social care professional 25
Lipid modification: patient decision aid https://www.nice.org.uk/guidance/cg181/resources/ 26
Atrial fibrillation: patient decision aid www.nice.org.uk/guidance/cg180/resources 27
Type 2 diabetes in adults: patient decision aid www.nice.org.uk/guidance/ng28/resources 28
Medicines optimisation: key therapeutic topics www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics Medicines optimisation: key therapeutic topics (KTTs) summarise the evidence base on topics identified to support medicines optimisation They are not formal NICE guidance These topics are selected and prioritised therapeutic areas where there are potential opportunities for maintaining or improving quality and improving value from our use of medicines NHS Digital lead on the development of comparators for the therapeutic topics included in the document 29
Medicines optimisation: key therapeutic topics https://www.nice.org.uk/about/what-we-do/our-programmes/nice-advice/key-therapeutic-topics Biosimilar medicines Anticoagulants: including non-vitamin K antagonist oral anticoagulants (NOACs) Acute kidney injury (AKI): use of medicines in people with or at risk of AKI Lipid modifying drugs Asthma: medicines optimisation priorities Hypnotics Low dose antipsychotics in people with dementia Wound care products Antimicrobial stewardship: prescribing antibiotics Type 2 diabetes mellitus: medicine optimisation priorities Non-steroidal anti-inflammatory drugs New topics 2017 Multimorbidity and polypharmacy Psychotropic medicines in people with learning disabilities whose behaviour challenges Safer insulin prescribing Medicines optimisation in long-term pain 30
Shared-learning Submitting a local practice example What are they? Shared Learning examples are real-life experiences from organisations that have used NICE guidance to change practice, improve care, and consider the way that health, social care and community-based organisations, use resources Details on the website Chris Bird able to help and support completion of examples 31
Evidence into practice Maskrey N, 2014 Research National guidance RNLI Local implementation Care of Individual people 32
Possible implementation issues for medicines optimisation (N L) Identify local implementation priorities Benchmark against each topic considering: Existing workstreams and achievements Local performance metrics such as prescribing information, medicines optimisation dashboard, RightCare and HES data, Identify potential challenges and barriers Develop a plan considering the options for implementation : Who needs to be involved, what resources do you need, how will you raise awareness and engage stakeholders? What do you need to do and how will you communicate this? What will success look like and how will you measure it? 33
NICE local practice case studies www.nice.org.uk/about/what-we-do/into-practice/local-practice-case-studies Title Published Improving the physical health of people with serious mental illness: A quality Jan 2017 improvement approach Adopting a multi-disciplinary approach to improve medicines accuracy in a general Jan 2017 surgical ward Refer-to-Pharmacy and Medicines Optimisation Jan 2017 Patient Led Clinical Medicines Reviews Jan 2017 Innovative ways to support smokers requiring nicotine management in a mental Jan 2017 health organisation Hypertension: Improving blood pressure management in primary care Jan 2017 Prudent Health Care Pilot Study to reduce the number of inappropriate lumbar Jan 2017 spine x-rays requested from primary care in the Princess of Wales locality Manchester Royal Infirmary Virtual Biologics Clinic Dec 2016 Improving and maintaining medicines reconciliation on admission Nov 2016 34
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Guidelines. Not tramlines. 36
Regional Technical Adviser Zoe.girdis@nice.org.uk 37