‘Way To Go’ – QNI Fund for Innovation Project Case Profile
8 February 2018 | Deena Geal - Project leader & Practice Nurse, Dorset.
In 2017 The Burdett Trust for Nursing funded 10 QNI nurse led Fund For Innovation projects focused around men’s health. One of these projects was led by Deena Geal, a Practice Nurse from Dorset. In this blog Deena discusses the case profile of one of her patients, ‘Robbie’* – demonstrating the power of simple but targeted local interventions.
‘Robbie was invited to participate in the ‘Way To Go’ Project. An opportunistic weight had been recorded some three years previously and he was coded with obesity with no pre-existing comorbidities. As a 58-year-old businessman, he travelled the country, working away from home all week. He rarely accessed health care services and had not previously responded to invitations to an NHS Health Check that were run within the surgery up until 2015.
Initially Robbie was hard to contact; however an opportunity to explain the service to his wife arose, followed by a promotional invitation letter detailing the individual approach to the project. This persuaded Robbie to make an appointment at a day and time that fitted in with his work schedule.
I asked Robbie to arrive 10 minutes prior to his appointment, allowing enough time for him to complete a questionnaire about his perception of how well he looked after his health, his understanding of what was meant by blood pressure, good and bad cholesterol, diabetes and importantly any specific concerns that he wanted to discuss in more detail. Robbie was also asked to complete an anxiety/depression screening tool.
The first appointment with Robbie aimed to capture baseline measurements of weight, BMI, blood pressure, waist circumference, cholesterol and blood glucose profile. These results, alongside his family and smoking history, determined cardiovascular and diabetes prediction using the QRisk2 and QDiabetes algorithms. These predictions would highlight the risk of heart disease and or type 2 diabetes in the next 10 years, comparing his risk to the average risk for a man the same age. The calculations also estimated Robbie’s heart age in comparison to his actual age.
A 30 minutes appointment was booked to discuss and respond to his feedback on the questionnaires and record the data. A follow-up appointment was arranged for two weeks later, to explain the results in detail and to support, educate and signpost Robbie to other services if appropriate, and to complete a Robbie’s personal health profile.
Robbie’s job was stressful, he reported drinking most evenings, consuming a total of 70 units within a week. He occasionally smoked, rarely exercised and he measured 10/21 using the Generalised Anxiety Disorder assessment score (GAD-7). This highlighted to Robbie that his experiences of anxiety could be affecting his day to day life and by recognising these feelings, he could seek support.
Robbie acknowledged that he was overweight, he felt frustrated by his lifestyle choices, yet found making healthier choices within the confines of a his daily life difficult. He thought the recommended national alcohol intake was 25 units per week.
His waist circumference was 122cm, 20cm above the recommended waist circumference target. His BMI was 35.3 and blood pressure 158/96 mmhg. While his cholesterol profile was within acceptable parameters, his BMI exposed him to increased risk of diabetes within a ten-year period, with a QDiabetes risk of 26.6% compared to 3.7% for someone his age. Robbie’s QRisk2 was 10.3% and his heart age was recorded as 70 years old, as a consequence of his body mass index.
Robbie was shocked by his risk of diabetes and heart age. He was keen to address the issues that he faced particularly when away with work. His personalised health profile and information pack reiterated advice that I shared with Robbie at his appointment about weight loss, reducing waist circumference, alcohol and signposting. Motivational interviewing techniques were adopted to support Robbie to identify achievable, sustainable and realistic goals within the confines of his daily life; I avoided using language such as ‘going on a diet’ but instead discussed changes in food choices, portion sizes and alternatives to red wine each evening, alongside realistic daily exercise targets.
Monthly reviews were an opportunity to support and encourage Robbie with the changes he was making; additionally it gave me insight as to whether Robbie had improved his knowledge about his health. A patient satisfaction survey identified if Robbie required further advice and education and whether this could be delivered within a men’s health forum or men’s health information evening.
As a clinician, the proactive approach to promoting Robbie’s well being and reducing the risk of development of long term diseases associated with obesity was an empowering experience. Over a six-month period Robbie achieved a 13 kg weight loss, a 15cm decrease in waist circumference, his BMI reduced to 31.2 and his blood pressure improved to 142/84mmhg without the aid of medication, although this was under review. He reduced his alcohol intake to 22 units/week. Having invested recently in a pedometer, when at work he never took the lift, always the stairs, and each weekend aimed to walk 6-14 miles. His QDiabetes risk decreased to 16%
Robbie’s feedback summarised succinctly what I had hoped to achieve when setting up the ‘Way To Go’ project.
A very useful service which has focused the mind on some important issues and given me the kick I didn't think I needed but probably did.'Robbie'*
*Names have been changed