Cambs CRFenPatientInvolvementEventReport 2011

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					Fenland Cardiac Rehabilitation Service:
 Patient Involvement Event 28th March
                 2011




Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Purpose:
To seek patients’ views and experiences of Fenland Cardiac Rehabilitation Service and
identify ways to improve this cardiac rehabilitation programme.

We decided to host a Healthy Heart Event and invite all patients who had attended either the
cardiac rehabilitation programme held in Wisbech or the programme held at Doddington
Hospital. Attendees were asked to evaluate (by questionnaire) Fenland Cardiac Rehabilitation
Service and, in anticipation that this could be a regular event, attendees were also asked to
evaluate the Patient Involvement Event itself.

Two Reports are detailed in this document:

       1.      Fenland Cardiac Rehabilitation Service: Programme Evaluation
               (pages 3 – 10)
       2.      Fenland Cardiac Rehabilitation Service: Healthy Heart Event Evaluation
               (pages 11 – 14)




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Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Fenland Cardiac Rehabilitation Service:
       Programme Evaluation




              Fenland Cardiac Rehabilitation Service: Programme Evaluation



                                                    3
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
We wished to gain opinion from patients who had attended Fenland Cardiac Rehabilitation
Programme about:

       the impact, if any, of this cardiac rehabilitation programme on their life
       what could have helped them further
       highlights and difficulties following recovery
       patient experience after cardiac rehabilitation (medication, GP follow-up etc)
       understanding of risk factors for coronary heart disease

Feedback was sought by questionnaire which patients completed at the event.
41 questionnaires were returned and details of the results are outlined below

Questionnaire Results:

What impact, if any, has cardiac rehabilitation had on your life?
Comments:
   Given me a new lease of life and more energy to do things – gardening, walking.
   Made me realise how unfit I have become
   Pleased with the help I have received.
   Not much impact but I think it did me good.
   Opened up, what effect diet has had on your health, what can be done through
      exercise to enable me to look after my heart.
   It made me more aware of how diet and regular exercise is important
   Nice to know someone was there to help
   My life is much slower
   My life has become much slower
   Improved my life
   I am able to do more things without getting breathless
   Had to slow down and take my time in general life
   Enjoyed the experience, still attending phase IV, had a set back whilst waiting for
      phase IV resulting in a pacemaker being fitted.
   Retired early due to kidney transplant. I go to healthy heart class at Hudson and aqua
      fit.
   Helped my recovery
   Given me more confidence regarding what I can’t do with regards to exercise etc.
   Made me exercise more, be careful what I eat and drink.
   It has given me the ability to change my eating and exercise habits and to read food
      labels. Also it has given me impetus to change my eating habits.
   It has enabled me to enjoy my life as before the problem.
   It helped me to begin exercising after my operation and to realise just how active I
      could become.
   More confidence in attempting various chores etc.
   Spurred me on to exercise at home and look closer at my diet.
   It enabled me not only improve my overall fitness – but the social side – mixing with
      people with the same problems in an enjoyable way.
   Good
   Slowed me down
                                              4
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
       Made me do more exercise
       Better health
       None
       A great impact regarding health and valuable information
       None, except the exercises.
       Slowed me down
       My wife says I am a new man!
       Very helpful and informative and a big help to regain my self confidence
       Greatly improved my health and approach to life
       I try to exercise more

Conclusions:
The comments are varied and therefore no consensus or conclusion can be drawn.

Looking back, if you were to go through the experience again, what could have helped
you further?
    The help I received was adequate. It helped my eating habits and exercise at home
    Earlier identification of the likely blockage and perhaps a stent earlier.
    More exercise lessons
    Raise my blood pressure before attending the class
    I can’t think of anything
    Nothing really. Excellent programme. Good laugh.
    Nothing
    Better diet and walking exercise
    Nothing really.
    Think of my age as regards activities I do.
    Been through it twice for different reasons, changed lifestyle, diet, exercise work.
      Don’t’ allow myself to be stressed.
    Very little
    I don’t know!
    Maybe a longer exercise session
    Nothing
    It was all fine.
    Having help to lose weight would have been of use even though there were healthy
      eating talks; I could have used more help in this respect.
    Service was excellent - needed no improvements.
    None that I can see.
    Nothing really.
    No.
    A new heart.
    Possibly a longer programme.
    None
    Don’t know.
    More information regarding the affects of angina after surgery.
    Don’t know.
    ?
                                                    5
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
       I had superb treatment throughout the experience, could not have wished for better.
        Good result – I’m still here!
       Perhaps I could have started the exercise programme a little earlier.
       No – because I knew the re-hab team were only a phone call away.
       Got help earlier.

Conclusions:
No consensus of opinion, some of the comments relate to lack of advice/support specific to
the individual, other comments are more directed at delay in diagnosis of heart disease.

What have been the highlights and difficulties of your recovery from your cardiac
event?
    Being able to walk without stopping. Difficulty – healing of the wound due to diabetes.
    Highlights – coming to the recovery programme and getting fitter and advice on what
      food are better. Difficulties – none really other than to remind me I’m getting older.
    Highlights – feeling a lot better.
    Highlights – was to complete a day. Difficulties was being sent home on a number of
      times before being allowed to start the programme.
    Re-hab. helped no end.
    Heart unrelated problems.
    The highlights are that I am able to go out and enjoy myself now.
    I find it hard to be as energetic as I was.
    Breathing better.
    The help and support afterwards.
    The speed and results with stents that were put in by Papworth.
    Realisation of how ill I had been and how well it helped my recovery. Main difficulty
      now is my inability to get travel insurance.
    Going to the programme, realised I could recover. Learning to become healthy again.
    Change of lifestyle, diet etc.
    Knowing that I can have a new lease of life. Difficulties were only not being able to do
      what I wanted to (very frustrating).
    Not many highlights but a lot of difficulties, mainly shortness of breath.
    Highlights –obviously recovering /meeting people at the cardiac rehab, doing he
      exercise and listening to the talks. Difficulties – realising that I cannot do things I used
      to – coping with nasty scars and swollen legs.
    Highlights – are that I have been able to have a lifestyle change.
    I have had all the support that was required.
    Having a ‘second chance’ has been brilliant although I have had several setbacks. I
      still feel that I have benefitted so much.
    General health seems better and getting about more.
    Highlights – feeling better. Difficulties – emotional and stressful side of the experience.
    Getting back to walking long distance.
    Meeting the nurses and exercising.
    Feeling better in myself. My breathing causes slight depression.
    Highlights – the love of my family. Difficulties - the emotional stress.
    Recent low blood pressure/ dizziness/headaches.
    Not really –body has slowed considerably, shortness of breath but no bad results.
                                                 6
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
       Highlight – a real sense of improvement at the end of course. Difficulties – the dreadful
        disability of the first few weeks following the CBG procedure.
     The highlight is the amazement of how quickly I recovered. The difficult is building up
        the confidence knowing what you can or can’t do.
     At times the uncertainty. Now know what to do when things get difficult.
     I can walk a lot further without getting breathless.
    Conclusions:
    Highlights appear to be about their recovery and returning to a feeling of wellness.
    Difficulties reported are varied – some related to medication, post operative experience
    and coping emotionally

Patient experience after completing the cardiac rehabilitation programme:

        Are you still taking your cardiac medications as prescribed by your GP?
               Yes - 100%
               No - 0 %

        Conclusion: there is maximal concordance with medication, albeit self reported.

        Have you had your medications altered or changed since your discharge from
        cardiac rehabilitation?
               Yes - 58%
               No - 42%

        Conclusion: without further information about which medications have been changed,
        no conclusion can be reached.

        Have you received a follow up from your GP/ practice nurse since your
        discharge from Cardiac Rehabilitation?
               Yes - 60%
               No - 40%

        Conclusion: It is surprising that 40% of attendees’ report that they have not have a
        follow-up with their GP or Practice Nurse since discharge from cardiac rehabilitation.

        Have you needed to go back to the GP with regards to cardiac related problems?
               Yes - 25%
               No – 75%

        If yes, please state the reason:
         To change my anti-acid tablets
         Having less energy
         Referral for a pacemaker
         Erratic heart beat
         Worried about pain but was muscular
         Angina symptoms
         Angina attacks

                                                    7
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
         Low blood pressure, headaches, dizziness.
         Chest pain, breathlessness
         Once – just had a bad day
         Irregular heart beat

      Conclusion: GP consultations appear to have been valid.

Please ring the risk factors that you are aware off that contribute to Coronary heart
disease:

Smoking, High Cholesterol, Stress, poor diet, Physical inactivity, Gambling, Diabetes,
extreme sports, age, swimming, gender, family history, alcohol, obesity, caffeine, high
blood pressure.

Results:
Disappointingly, only 4% correctly identified all 12 risk factors for coronary heart disease.
16% were unable to correctly identify 5 or more risk factors and 22% thought that caffeine,
extreme sports and gambling are risk factors for coronary heart disease. 8% did not answer
this question and 6% only identified 1 or 2 risk factors which could lead us to conclude that
their either do not understand what the risk factors are or did not understand the question or
even could not be bothered to answer the questions.

Understanding of coronary heart disease risk factors:

Can you personally identify a risk factor that you have addressed over the past year?
Results:
16 patients reported that they had addressed none of the risk factors although it is not clear
that they had any modifiable risk factors to address.

A small number of patients reported that they had addressed more than one risk factor. And
one person stated that they had addressed all the risk factors! Of the risk factors addressed,
diet was the most popular, 10 patients reporting that they had addressed this aspect.

Are there any modifiable risk factors that you have not been able to address or have
struggled with?

Results:
33 respondents reported that they did not have any problems or struggle with addressing
modifiable risk factors.
5 reported that they were struggling with diet (2), smoking (1), weight (1) and stress (1).

The question may have been too ambiguous to illicit a meaningful response in that we do not
know if they had any risk factors to address or if they did address them if they actually coped
well.

Have you had any further re admissions into hospital since your discharge from
cardiac rehabilitation in relation to your heart?


                                                    8
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
If yes please state dates of admissions:
Results:
6 respondents reported that they had been admitted into hospital. 2 patients had 2 hospital
admissions in the last year. One patient was admitted to hospital for insertion of a Permanent
pace-maker.

Conclusion and improvement opportunities

Programme format and content:
Feedback from patients about what could have improved their experience is varied and no
clear trends were identified. Some of the comments related to this programme but also some
comments related to patients’ experience pre or post cardiac event.

Planned actions
Comments relating to specific elements of the programme, for example ‘more exercise
sessions, longer programme, weight management advice have been/will be included in the
timetable.

To ensure that the programme meets individuals’ needs, we will build time into the session to
speak to new starters and check that we are providing a service that is relevant to them and
document their needs.

GP follow-up
40% of respondents reported that they had not had a follow-up since discharge.

Planned actions
Ensure that patients are given detailed written information regarding follow-up post cardiac
rehabilitation programme e.g. frequency of blood pressure checks and routine blood tests.

Identification of Risk Factors
Very few people could correctly identify all risk factors.

Planned actions
A pre and post check of understanding will be implemented into the risk factor talk in order to
ensure that our education element of the programme is effective. .

Format/method of Fenland Cardiac Rehabilitation Service programme evaluation
Having analysed the information, it is clear that some questions have not been understood,
are ambiguous or not specific enough to gain meaningful information to evaluate the
programme effectively.




Planned actions



                                                    9
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Examine whether the format used is the most appropriate method for this purpose and
whether alternative low cost/low resource methods could be implemented in the future e.g.
focus group.

Additional actions
Our next task is to identify reasons for people not wishing to take part in any form of cardiac
rehabilitation programme in order to increase participation and reduce the risk of coronary
events in Fenland.




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Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Fenland Cardiac Rehabilitation Service:
                       th
 Healthy Heart Event 28 March 2011




                                                   11
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
                               Healthy Heart Event Evaluation Report

Aims of the event:
    provide a format that would encourage patients to take part in Fenland Cardiac
     Rehabilitation Service Programme Evaluation
    make available information and resources that would encourage CVD risk factor
     reduction
    increase working opportunities with Partner organisations

Attendees
80 past patients were invited to attend, 67 patients and spouses/carers confirmed their
attendance and 57 actually attended the Event on the 28/03/2011 (this included 6
spouses/carers).

Supporters of the event
In addition to the cardiac rehabilitation team, the following Partners also attended the event
and provided information and resources

              Contact Name              Organisation/ Topic

              Chris Hampson             PALS, CCS

              Sheila Collins            Camquit

                                        Hudson Leisure Centre
              Lisa Bulbeck              Fenland Leisure Services

              Steph Shadwell            Personal Health Trainers

              Jane Green                Community Dietician CCS

              Heart Failure Nurses      BHF Stand & BP Checks

              Heart Failure Nurses      Drink Aware

              Heart Failure Nurses      Diabetes information

              Paul Brown, Anglia
              Stroke and Heart
              Network



Event Structure:
Patients were greeted and asked to complete a questionnaire to establish the objectives as
detailed in: Fenland Cardiac Rehabilitation Service: Programme Evaluation document.


                                                   12
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
A ‘Healthy Food’ demonstration was held; this showed how to make a healthy lunch
consisting of: coleslaw, mackerel pate and red fruit salad.

At approximately 13.15, a buffet was available to all attending the event. The buffet provided
an attractive range of healthy sandwiches, dips, crudités and fruit skewers, providing an
opportunity to sample food prepared with the same low fat/salt principles outlined in the
demonstration.

Attendees were encouraged to visit the interactive information stands and complete a ‘just for
fun’ quiz about what they had seen/found out.

The event closed with a raffle (a selection of good quality prizes having been donated by local
firms and attendees) and an evaluation questionnaire for the Event.


Feedback from attendees about the event
Attendees were invited to complete a short evaluation questionnaire covering key elements of
the event against a 1 – 10 scale. Attendees were also invited to make comments against
each question and also asked to make comments about how the event could be improved.

32 evaluation forms were returned. Results as follows:

1) Attending the event has been of benefit to me
1       2       3       4      5       6        7              8         9      10
0%      0%      0%      0%     3%      0%       3%             13%       25%    56%
Disagree strongly                Unsure                                     Agree strongly


2) Information stands and resources available were appropriate to my needs
1       2        3      4      5       6       7       8       9       10
0%      3%       0%     0%     0%      0%      3%      6%      28%     60%
Disagree strongly                Unsure                            Agree strongly


3) Healthy Food Demonstration was informative
1       2      3     4        5       6       7                8         9      10
3%      0%     3%    0%       6%      6%      3%               6%        28%    44%
Disagree strongly               Unsure                                      Agree strongly

Comments:
Didn’t mention washing hands or any fruit. Same knife used throughout. Anti-bacterial wipes
should have been used. Even if demonstrator did have a food certificate, would not have
tasted food as it was out of refrigeration for more that 20 minutes.

4) Food and refreshments served at the event today were
1      2        3     4       5        6       7       8                 9      10
0%     0%       0%    0%      0%       0%      0%      0%                6%     94%
Poor                            Unsure                                            Good
                                                   13
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Comments:
If you like that kind of food.

5) Facilities within the recreational hall today were
1        2        3        4       5         6     7           8         9      10
0%       0%       0%       0%      0%        0%    0%          16%       22%    62%
Poor                                 Unsure                                       Good

6) The format of the event today was well structured
1       2       3       4       5      6         7             8         9      10
0%      0%      0%      0%      0%     0%        0%            15%       19%    66%
Disagree strongly                 Unsure                                    Agree strongly


7) How do you think the event could be improved?
Comments:
 With difficulty
 Food etc excellent. Staff all very helpful – a very good event.
 A really good informative time, keep up the good work.
 I think it was about right
 Well presented, difficult to consider improvement
 Not so long next time – 2 hours max
 Food demonstrator could do with a mic. – some of us old folk’s hearing isn’t as good these
   days.
 It was good – everyone helpful.
 Good as is – thank you
 I think it was very good and everyone was helpful – a very good team
 Very well done.


Overall, the event was a success and met its original aims and appears to have been
thoroughly enjoyed by all those who attended.




                                                   14
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk
Acknowledgements:


    •   We are grateful to Anglia Stroke and Heart Network for providing practical support and
        funding for this event.
    •   To ALL the Partners for taking time out of their busy schedules to be present at this
        Event
    •   Of course: to all the past patients (and their spouses/carers) who attended and helped
        to make this Event a success “Thank you”




                                                   15
Cambridgeshire Community Services NHS Trust: providing services across
Cambridgeshire, Peterborough, Luton and Suffolk

				
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