Long term conditions and multimorbidity

Question 1

Define long term condition.

Answer 1

Long term conditions are health conditions that last a year or longer, impact on a person’s life, and may require ongoing care and support

Question 2

Graph relationship between obesity and type 2 diabetes mellitus.

Answer 2

Refer to slide 8

Question 3

Graph relationship between obesity and mean age of onset of DM II.

Answer 3

Refer to slide 9

Question 4

How is obesity related to diabetes ?

Answer 4

• Insulin resistance is closely linked to abdominal obesity
• As body weight increases, insulin resistance increases
• Reducing abdominal obesity improves insulin sensitivity

Question 5

How much does weight loss increase life expectancy among obese diabetic patients ? What are other benefits of weight loss ?

Answer 5

5% weight loss = 4.5 kg = 22% of excess wt = 40% of excess abdominal fat

Reduces blood pressure, improves lipid profile, glycaemic control

Question 6

What number of people are diagnosed with type 2 diabetes in Scotland ? How many people in Scotland are at high risk of developing type 2 diabetes ?

Answer 6

17, 000 diagnosed with type 2 diabetes

500, 000 people at high risk of developing type 2 diabetes

Question 7

Identify the top 3 long terms conditions in Scotland in terms of number, cost, and beddays.

Answer 7

NUMBER OF INDIVIDUALS

1) Arthritis
2) Asthma
3) Cancer

TOTAL COST

1) Cancer
2) Arthritis
3) Diabetes

TOTAL BEDDAYS

1) Arthritis
2) CHD
3) Cancer

Question 8

What is SPARRA: Scottish Patients at Risk of Readmission and Admission ?

Answer 8

Risk prediction tool

• Identify those patients most at risk of emergency admission in the coming year
• Feed back probabilities and details of patients to front-line teams
• As basis for:
Further assessment to identify those patients who will benefit most from preventive interventions e.g. intensive case management

Question 9

Describe the case management approach for high health gain individuals in Fife ?

Answer 9

 Integrated approach to care co-ordination for individuals identified as high health gain
 Provide targeted proactive case management
 Engaging with people in their communities to
minimise crises
 People will experience greater independence and participation in their valued activities from improved health and wellbeing
 People will have fewer unplanned hospital admissions, require out of hours services less frequently and have fewer GP consultations

Question 10

Identify some key elements of early detection of diabetes. Who is this aimed at ?

Answer 10

Those at risk

• Self-assessment risk
• Professional risk stratificatin
• Accessible info
• Weight management programmes

Question 11

Identify some key elements of early intervention of diabetes for high risk people.

Answer 11

• Professional risk stratification
• Early diagnosis
• Targeted support
• Specialist intervention

Question 12

Identify some key elements of early intervention of diabetes for patients with type 2 Diabetes.

Answer 12

• Early diagnosis
• Structured education
• Specialist education
• Person-centered care plans

Question 13

Graph number of chronic disorders by age group.

Answer 13

Refer to slide 18

Question 14

Graph percentage of patients with two or more conditions, depending on age, for different deciles of deprivation.

Answer 14

Refer to slide 19

Question 15

Identify new approaches towards life conditions.

Answer 15

• NICE Guidance
• SPARRA
• Good Conversations
• ADL Lifecurve Approach
• New GP contract?
• High Health Gain
• Patients initiative

Question 16

Describe the Good Conversations approach to long term conditions.

Answer 16

Approach which aims to engage with the person and significant others to find out what matters to them, what they hope for and what they want to be different in their lives. An outcomes approach involves thinking about what role the person themselves might play in achieving their outcomes, which can be a significant shift from more traditional services where the solutions are viewed as located on the service side.

Question 17

Describe the ADL lifecurve approach.

Answer 17

Tool used to map age related functional decline. It provides a framework for understanding the most appropriate stage to intervene and which interventions are most effective.

Question 18

Draw the ADL lifecurve.

Answer 18

Refer to slide 25

Question 19

Describe the New GP Contract.

Answer 19

“Joint agreement between the Scottish Government and the BMA, which aims to improve access for patients, address health inequalities and improve population health”

Question 20

Describe the link between expenditure and proportion of service users.

Answer 20

2. 3% of population are responsible for half of expenditures (these are high health gain individuals, tend to have more long term conditions)
3. 7% of population are responsible for 5% of expenditures

Question 21

How are high health gain individuals identified ?

Answer 21

 Clients identified using a risk stratification tool - High Health Gain developed by ISD
 Primary and secondary care data triangulated
 Based on past medical history, number of LTC,
number of emergency admissions
 Frailty scores utilising a focused Frailty tool.

Question 22

Distinguish between the new, and old model of case management for high health gain individuals.

Answer 22

OLD

• Single issue focussed
• Crisis management and late presentation
• Heavily dependent on bed based care
• Disjointed
• Episodic – cases closed, discharged

NEW

• Integrated care focussed on LTC’s and frailty
• Timely identification and proactive care
• Care delivered as close to home as possible within communities
• Services joined up with single point of access

Question 23

Describe prevention of LTCs.

Answer 23

1. Prevention strategies focus on some key issues that contribute to high burden LTCs – physical activity, mental wellbeing, healthy diet, and reducing substance use
2. Have to be informed by our understanding of the impact of deprivation, adverse childhood experiences, and trauma

Question 24

What is the public health priority number 6 ?

Answer 24

About healthy weight, diet, physical activity

Question 25

Identify the main outcomes underpinning diabetes prevention and early intervention framework.

Answer 25

Outcome 1: Children have the best start in life – they eat well and have a healthy weight

Outcome 2: The food environment supports healthier choices

Outcome 3: People have access to effective weight management services

Outcome 4: Leaders across all sectors promote healthy diet and weight

Outcome 5: Diet-related health inequalities are reduced

Question 26

Identify a recent population level approach which may contribute to improvement in obesity.

Answer 26

SUGAR TAX