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TIER 1- Children TIER 2 TIER 3 TIER 4 TIER 1-Adults TIER 2 TIER 3

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TIER 1- Children TIER 2 TIER 3 TIER 4 TIER 1-Adults TIER 2 TIER 3 Powered By Docstoc
					                                                                           NHS ROTHERHAM OBESITY MODEL
                                                                                                                         (July 2009)
                                                                                          (BMI = Body Mass Index, wc = waist circumference)
                                                                                                                                                                                                           SECONDARY CARE
                                                                                                                              Increased risk in adults                                                     e.g. Cardiology
        Increased risk in children                                                                                                                                                                              Diabetology
        e.g. Type 1 diabetes                                                                                                  e.g.Type 1 diabetes
                                                                                                                                  Tablet controlled T2DM                                                        Gastroenterology
             Tablet controlled T2DM
                                                                                                                                  Dyslipidaemia                                                                 Respiratory
             Special circumstances
                                                                                                                                  South Asian men                                                               Surgery
                                                                                                                                  Established CVD,                                                              Obstetrics/Gynaecology/Maternity
                                                                                                                                  Sleep apnoea                                                                                   (Fertility/PCOS)
                                                                                                                                  etc                                                                           Orthopaedics
                                                                                                                                                                                                                Rheumatology
                                                           TIER 4                         SECONDARY CARE                                                                                                        etc.

                                                           Specialist
                                                                                          e.g. Paediatrics
                                                                                               Surgery
                                                                                                                                                                           TIER 4                          MUSCULOSKELETAL (physio/podiatry)
                                                                                                                                                                                                           COMMERICIAL SECTOR
                                                       interventions eg,                       Orthopaedics                                                                Specialist                      e.g. Weight Watchers
                                                after     CARNEGIE       after            MUSCULOSKELETAL (physio/podiatry)                                      after interventions eg,      after             Slimming World
                                               tier 3 residential camps   tier 4          SOCIAL SERVICES                                                       tier 3  bariatric surgery      tier 4      PHARMACY
                                              assessment               intervention                                                                           assessment                 intervention
                                                                                                       Refer                                                                                                            Refer
                                                                                                    to tier 3 or                                                                                                     to tier 3 or
                                                                                                  recommend                                                                                                        recommend
                                                                                                tier 2                                                                                                           tier 2
                                                                                              as appropriate                                                                                                   as appropriate
                                    if
                                  tier 2                   TIER 3                after
                                                                                  tier 3
                                                                                                                                                      if
                                                                                                                                                    tier 2
                                                                                                                                                                           TIER 3                  after
                                                                                                                                                                                                    tier 3
                                intervention                                                                                                      intervention Specialist MDT Obesity Service intervention
                                             Specialist MDT Obesity Service intervention
                               exhausted                                                                               If BMI > 40               exhausted Rotherham Institute for Obesity (RIO)
If BMI centile                              Rotherham Institute for Obesity (RIO)
> 99.6th centile                                   (REFERRAL ONLY)                                                  or BMI > 30                                       (REFERRAL ONLY)
or                                                                                                             or wc > 88cm
> 95th centile                                                                                               or wc > 102cm ♂
with ↑ risk                                                                                                      with ↑ risk
                           if                                                                     after                                      if                                                                    after
                         BMI centile                                                               tier 2                                   BMI 25-40                                                               tier 2
                      85th – 99.6th                                                          intervention                                or wc > 80cm                                                         intervention
                     recommend tier 2                                                                                                  or wc > 94cm
                   self referral                           TIER 2                                                                     recommend tier 2                     TIER 2
                                                                                                                                     self referral
                                         Community Weight Management Service                                                                              Community Weight Management Service
                                          (diet/nutrition/lifestyle/exercise education)                                                                    (diet/nutrition/lifestyle/exercise education)
                                             CARNEGIE CLUBS via DC Leisure                                                                                         RESHAPE ROTHERHAM
                                                       (SELF REFERRAL)                                                                                                  (SELF REFERRAL)

                                               TIER 1- Children                                                                                                    TIER 1-Adults
                                                      Primary Activity                                                                                                 Primary Activity
                                        Population wide basic intervention & prevention                                                                  Population wide basic intervention & prevention
                                            e.g. GP, Health Visitor, School Nurse                                                                           e.g. GP, Health Visitor, Leisure Services
                                                           e.g. Maternity Matters, UNICEF Baby Friendly, Early Years, Play Path Finder, Healthy Schools, Ministry of Food
                                                                          Leisure & Green Spaces, Transport & Planning, Workplaces, Built Environment etc


        Any TIER 3 patient requiring pharmacotherapy will be treated in TIER 3, and this will be reflected in the GP prescribing data for whom the patient is registered
        NB If patients are considered unsuccessful at any given tier, they automatically progress to the next tier of intervention
           After intervention, patients progress down through the tiers and back to primary activity (TIER 1) of monitoring and education (every 6-12 months)
                NHS ROTHERHAM OBESITY MODEL: Children
                                                                         (July 2009)
                                                                (BMI = Body Mass Index)

                               Increased risk in children
                               e.g. Type 1 diabetes
                                    Tablet controlled T2DM
                                    Special circumstances




                                                                                TIER 4                          SECONDARY CARE
                                                                                                                e.g. Paediatrics
                                                                                 Specialist                          Surgery
                                                                             interventions eg,                       Orthopaedics
                                                                      after     CARNEGIE       after            MUSCULOSKELETAL (physio/podiatry)
                                                                     tier 3 residential camps   tier 4          SOCIAL SERVICES
                                                                   assessment                intervention
                                                                                                                             Refer
                                                                                                                          to tier 3 or
                                                                                                                        recommend
                                                                                                                      tier 2
                                                                                                                    as appropriate

                                                           if
                                                         tier 2                 TIER 3                  after
                                                                                                         tier 3
                                                       intervention
                                                                    Specialist MDT Obesity Service intervention
                                                      exhausted
                       If BMI centile                             Rotherham Institute for Obesity (RIO)
                       > 99.6th centile                                  (REFERRAL ONLY)
                       or
                       > 95th centile
                       with ↑ risk
                                                  if                                                                    after
                                                BMI centile                                                              tier 2
                                             85th – 99.6th                                                         intervention
                                            recommend tier 2
                                          self referral                         TIER 2
                                                               Community Weight Management Service
                                                                (diet/nutrition/lifestyle/exercise education)
                                                                   CARNEGIE CLUBS via DC Leisure
                                                                             (SELF REFERRAL)
                                                                                TIER 1
                                                                          Primary Activity
                                  e.g. Maternity Matters, UNICEF Baby Friendly, Early Years, Play Path Finder, Healthy Schools,
                                      Ministry of Food, Leisure & Green Spaces, Transport & Planning, Built Environment etc
                                                                e.g. GP, Health Visitor, School Nurse



Any TIER 3 patient requiring pharmacotherapy will be treated in TIER 3, and this will be reflected in the GP prescribing data for whom the patient is registered
                    NB If patients are considered unsuccessful at any given tier, they automatically progress to the next tier of intervention
       After intervention, patients progress down through the tiers and back to primary activity (TIER 1) of monitoring and education (every 6-12 months)
                   NHS ROTHERHAM OBESITY MODEL: Adults
                                                                         (July 2009)
                                           (BMI = Body Mass Index, wc = waist circumference)
                                                                                                                SECONDARY CARE
                                    Increased risk in adults                                                    e.g. Cardiology
                                    e.g.Type 1 diabetes                                                              Diabetology
                                        Tablet controlled T2DM                                                       Gastroenterology
                                        Dyslipidaemia                                                                Respiratory
                                        South Asian men                                                              Surgery
                                        Established CVD,                                                             Obstetrics/Gynaecology/Maternity
                                        Sleep apnoea                                                                                  (Fertility/PCOS)
                                        etc                                                                          Orthopaedics
                                                                                                                     Rheumatology
                                                                                                                     etc.
                                                                                TIER 4                          MUSCULOSKELETAL (physio/podiatry)
                                                                                                                COMMERICIAL SECTOR
                                                                                Specialist                      e.g. Weight Watchers
                                                                      after interventions eg,      after             Slimming World
                                                                     tier 3  bariatric surgery      tier 4      PHARMACY
                                                                   assessment                 intervention
                                                                                                                             Refer
                                                                                                                          to tier 3 or
                                                                                                                        recommend
                                                                                                                      tier 2
                                                                                                                    as appropriate

                                                            if
                                                          tier 2
                                                                                TIER 3                   after
                                                                                                          tier 3
                                                        intervention Specialist MDT Obesity Service intervention
                             If BMI > 40               exhausted Rotherham Institute for Obesity (RIO)
                          or BMI > 30                                      (REFERRAL ONLY)
                     or wc > 88cm
                   or wc > 102cm ♂
                       with ↑ risk
                                                   if                                                                   after
                                                  BMI 25-40                                                              tier 2
                                               or wc > 80cm                                                        intervention
                                             or wc > 94cm
                                            recommend tier 2                    TIER 2
                                           self referral
                                                               Community Weight Management Service
                                                                (diet/nutrition/lifestyle/exercise education)
                                                                        RESHAPE ROTHERHAM
                                                                             (SELF REFERRAL)
                                                                                TIER 1
                                                                         Primary Activity
                                     e.g. Maternity Matters, UNICEF Baby Friendly, Ministry of Food, Leisure & Green Spaces,
                                                     Transport & Planning, Workplaces, Built Environment etc
                                                              e.g. GP, Health Visitor, Leisure Services



Any TIER 3 patient requiring pharmacotherapy will be treated in TIER 3, and this will be reflected in the GP prescribing data for whom the patient is registered
                    NB If patients are considered unsuccessful at any given tier, they automatically progress to the next tier of intervention
       After intervention, patients progress down through the tiers and back to primary activity (TIER 1) of monitoring and education (every 6-12 months)

				
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