Tackling the ‘Big Three’ health issues in the Western Isles

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Three of the biggest public health issues facing NHS Western Isles in the 21st century - smoking, alcohol abuse and Coronary Heart Disease – are being tackled head-on by the local Health Board, with recently introduced preventative measures exceeding expectations and achieving considerable health benefits for the local population.

Taking into account the health issues linked to smoking and alcohol abuse, coupled with the fact that the Western Isles has a particularly high rate of Coronary Heart Disease (CHD), NHS Western Isles has taken innovative steps to successfully tackle these issues over the past year. Focusing on the prevention of illness through screening, advice and education, the Western Isles is now one of the highest achieving Boards in Scotland in the delivery of government targets which relate to these three health issues.

Universal screening to tackle CVD:

An innovative project to provide universal health checks to people aged between 40 and 69 was introduced by NHS Western Isles in May 2008. Known as ‘Well North’, the project has gone from strength to strength over the past two and a half years; leading the way in Scotland in the early delivery of the government’s cardiovascular health check target and being the first Board in Scotland to introduce instantaneous access to Coronary Vascular Disease (CVD) and Diabetes screening test results through Point of Care Testing.

The government target for cardiovascular health checks specifies that people within the target age group (between 40 and 69) in locally deprived areas should receive health checks. NHS Western Isles however has taken a universal approach and offers screening to every member of the population that falls within the target age range - which equates to around 8,200 people. Already more than two thirds of people within that age group have received a health check.

“Nobody anticipated how successful the ‘Well North’ screening programme would be when it was first introduced in 2008,” said Chair of the Coronary Heart Disease and Stroke Managed Clinical Network, and Clinical Lead for Well North, Dr Dave Rigby. “The project recently reached the milestone of providing our 5,000th health check through Well North, which means that more than two thirds of those eligible for screening in the Western Isles have now received a health check. We hope to have seen the majority of the 8,200 target group within the next year. I doubt if there is another primary prevention initiative in the country that has achieved so much and had such a big impact on this age group.”

As part of the Well North project, individuals are given an overall health check and risk estimation score. If, following a health check, a client is found to be at a 20 per cent (or higher) risk of developing CHD in the next 10 years, measures can be taken (such as an increase in exercise) to prevent the disease forming. Clients at a 20 per cent or above risk are also referred back to their GP. Those in a slightly lower risk group will be offered support such as sports programmes in the sports centre or healthy eating advice.

The fact that Well North clinics are effectively ‘mobile’ and held in a variety of community venues to suit different individuals is thought to have been a key factor in the success of the project, coupled with the fact that individuals receive personal invitations, by letter or phone, to attend health checks.

Tackling Alcohol Abuse – a culture change:

The excessive consumption of alcohol is a huge public health issue across Scotland - but through initiatives like no-stigma Alcohol Brief Interventions (ABIs), NHS Western Isles has taken significant steps to help prevent potentially dangerous drinking patterns developing.

With a target to deliver 772 ABIs interventions over a three year period (from March 2008 - March 2011), NHS Western Isles has delivered more than double the target number (1,560 by the end of February 2011). Brief interventions were introduced as a new and innovative way to tackle alcohol problems within the community and focus on preventing problems before they develop. ABIs typically take the form of short motivational interviews, in which the costs of drinking and the benefits of cutting down are discussed, along with information about health risks.

Health Promotion Manager Colin Gilmour explained: “Alcohol Brief Interventions offer a structured approach that improves the likelihood of letting people more accurately assess their own drinking patterns and increase our staff’s abilities to intervene and encourage safer ways of drinking where appropriate. The Well North Project was such a successful vehicle to deliver health checks that we decided to offer Alcohol Brief Interventions as part of the Well North project.

“Most of the people we screen and carry out an intervention with are able to consider reducing their consumption or patterns of drinking with our help, but because of the approach we occasionally are able to help people with existing alcohol problems but who have not come forward to existing services.”He added: “It was felt that this approach was much more likely to engender culture change, firstly within the organisation and secondly within the population. Making lifestyle changes, such as reducing your alcohol consumption or stopping smoking, can also reduce the risk of coronary heart disease and stroke.”

Alcohol Brief Interventions are also carried out in the Western Isles in Accident and Emergency Departments, GP Surgeries, and in Maternity Units.

Smoking – quit rates at an all time high:

For the past two years, NHS Western Isles has consistently achieved the highest one month and three month ‘quit rates’ in Scotland, and the local service is continually developing to meet the needs of clients.There are a number of factors behind the recent success of the local smoking cessation service; including the fact that the service is island-wide, covering the Butt to Barra; that home visits are available in certain circumstances; and that people can either self refer, be referred from Well North or can be referred from their GP. Practice staff, frontline staff, dental staff and pharmacy staff are also excellent at referring clients to the service. Individuals referred to the service from their GP are contacted within five days of referral.

The government’s smoking cessation target requires NHS Western Isles, through its Smoking Cessation Services, to support eight per cent of the smoking population to successfully quit at one month post quit date over the period April 2008 to March 2011. This equates to a target of 434 quits. As at March 8 2011, the number of successful smoking quits for the Western Isles Health Board was 478.

Specialist Smoking Co-ordinator, Joanne O’Donnell said: “We have had a steady increase in the number of self referrals to the smoking cessation service. If people access the specialist services we provide, they will be four times more likely to successfully quit than if they do not receive support.”

The Smoking Cessation specialists work with clients to set an appropriate and workable quit date and also discuss the barriers to quitting with clients. The specialists come from a variety of backgrounds and have varied skills to support people throughout the process and cycle of change.

One of the clients of the Smoking Cessation Service, Murdo Macleod from Stornoway, commented: “I have tried many times to stop smoking on my own and although have managed for a few days or on occasion a couple of weeks, I have always lapsed. I first joined the Smoking Cessation Service on a one-one to basis and then started attending the group sessions in the Cearns and initially managed for 20 days and then lapsed.

“Going to the group pulled me back and with the support of the advisor, I set myself a new target of 21 days and I am delighted to report that I am still smoke-free six months on. The support service gives you all the help and encouragement you need when times are difficult and others from the group are also on hand with tips and ideas to keep you going. It worked for me and I would recommend anyone who is trying to quit smoking to get some support from Smokefree Hebrides. I did it and you can too.”

In addition to the excellent ongoing work to support smokers to quit, the Smokefree Hebrides team also offer a Smoking Prevention service – an initiative aimed at stopping young people from starting the habit in the first place. This is being taken forward through education (including peer education) in schools as well as local football clubs, where messages such as ‘Smoke Free Homes’ and ‘Smoke Free Cars’ are promoted.

NHS Western Isles Chief Executive Gordon Jamieson said: “I am delighted that here in the Western Isles we are making such excellent progress to tackle these three major public health issues. Smoking and alcohol abuse can both lead to a number of serious health problems, and premature death from heart attacks, high blood pressure and strokes. The innovative approaches we have introduced to encourage healthier lifestyles are already reaping positive results. Our successful universal screening programme for CVD also enables us to pick up the early risk factors which could indicate the onset of CHD.

“The measures we have taken to tackle these areas have resulted in the Western Isles leading the way in the delivery of national targets, but more importantly have helped give the local population the opportunity to keep as healthy as possible.”