Lifestyle statin Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
Explores patients understanding of lifestyle factors associated with CVD risk
“Do you know of any lifestyle factors that can increase a person’s risk of getting heart disease?”
HPC
Weight history (Current weight/ recent changes in weight) - “what is your weight currently?”, “has this stayed fairly constant or has there been any changes?”
Occupation/Current activity levels - “what do you currently do for work?”, “do you get some exercise each day?”, “how many hours/minutes do you spend exercising each day?”
Smoking status - “do you smoke?”, “how many do you smoke in a day?”, “how long have you smoked for?”
Living arrangement (single/ married) Family/ friends social support - “what’s your home situation like?”, “are you single or married?”, “do you have a good support circle/network?”
Previous attempts to change lifestyle behaviours - “have you tried to make changes to your lifestyle behaviours in the past?”, “how did you find it?”, “what did you find the hardest to change?”
PMH
“Do you have any medical conditions like previous heart attack, or any other heart conditions?”
DH
- “Are you on any medications that have been prescribed by your doctor?”, “do you take any over the counter medications?”*
- “Do you have any allergies to any medications? What happens when you take the medication?”*
FH
Family history (hyperlipidaemia, MI, Stroke, Diabetes-specifically asks about 3 G, 2 A)
“Do you have any FHx of high cholesterol, heart attack, stroke or diabetes?”
Examination
Asks to examine patient (G if gives two examples: e.g. BP, check pulse)
“I’d like to examine you now by checking your pulse and measuring your blood pressure. Is this ok with you?”
Counselling
Uses QRisk score to explain his personal risk over 10 years (done well G) - “I’ve got the results of a test called the QRisk score, which is calculated based on the information you’ve given me and the examination such as your smoking status and your blood pressure. It estimates the risk of you getting a stroke or a heart attack within the next 10 years.”
Explains that a statin is indicated by QRisk score but long term medication and benefit likely to be small - “If this score is above 20% we start our patients on statins long term. So at the moment, you have a 32% chance. However, the benefit is not likely to be a lot.”
Blood pressure normal but BMI slightly elevated (G for both) - “Your blood pressure is normal, but your BMI is slightly elevated.”
30 minutes moderate activity 5 x per week / Reduce time sitting - “For practical steps, it’s important that you increase your activity level to 30 minutes of moderate activity for example going for a walk or a light jog, 5 times a week. Also, we advise that you reduce the time you spend sitting. If you take the bus to work, you could get off like 2 or 3 stops before and then walk the rest of the way.”
Limit alcohol to 2-3 units/ day (14 units per week). Explain this has recently changed for men - “Also reduced your alcohol intake to 2-3 units a day or 14 units per week. This might surprise you, but the guidelines have recently changed for men.”
Healthy eating advice (G if mentions DASH diet) - “Diet is really important, and we advise that you limiting the amount of salt you take, take 4-5 servings of vegetables and fruit each day and try to avoid food that are high in added sugar like fizzy drinks and sweets.”
Suggests smoking cessation (G if mentions where available: pharmacy or NHS stop smoking telephone line) - “Stopping smoking can be hard, but there are smoking cessation services available at the pharmacy and also the NHS stop smoking telephone line. I’ll write down the number for you after the consultation.”
ICE-ish
Explores patients own goals with regards to health and lifestyle change (e.g lose weight/ increase physical activity/ improve diet) - “have you got any goals in mind regarding your health and lifestyle changes.”
Considers personal barriers (e.g., social, cultural, pyschological, economic factors) - “is there anything your worried about that might make achieving your goals hard?”
Uses culturally appropriate language which is clear and concise
Maintains non-judgemental attitude and demonstrates empathy in discussions.
Closing the consultation
Considers social referral (health trainer/ weight loss group/ dietitian) - “I could get a social prescriber involve to find a health trainer, or a weight loss group if you would like this?”
Direct to appropriate online materials/ provides a leaflet - “Thank you so much for speaking with me today. Before you go I’d like to give you a patient information leaflet. A great website to go to is arthritis research UK, which I’ll write on a piece of paper for you to take home with you.”
Arranges a follow up appointment to review (e.g. 6 weeks) - “I’d like to book a follow-up appointment to see you in 6 weeks. Are there any days that works best for you?”
