Passport to Health Service
Transcript of Passport to Health Service
1
Making Bath & North East Somerset an even better place to live, work and visit
Updated on16/11/2011
Bath & North East Somerset’s
Exercise Referral Scheme
Passport to Health Service
working together for health & well-being
2
Contents
Introduction 3 Overview of the scheme 4 Referral Guidelines 5 Operating protocol for Referrers 6 Operating protocol for Referral Exercise Professionals 7 Activity Pathways 8 Help us to help you 9 Appendices Referral form 10 Irwin & Morgan Risk Stratification Tool 11
3
Introduction
This guide has been produced in response to the National Quality Assurance Framework (NQAF) for Exercise Referral Systems (2001) and Professional and Operational Standards for Exercise Referral: The Joint Consultative Forum of Medical Royal Colleges, The Faculties of Health & Sport and Exercise Medicine, The Chartered Society of Physiotherapy and the Fitness Sector of the United Kingdom (2011). The guide aims to provide all professionals involved with the Passport to Health Scheme a point of reference when referring to the programme, ensuring a standardised and consistent service is offered equally to all of its users. Updates to material included in this guide will be issued by the Project Officer - Health, who will request that you take responsibility for replacing the out-of-date information with the new material. Receiving this guide and adhering to all guidelines, procedures and protocols provides accreditation to the Passport to Health referral service.
4
Overview of the Scheme
The Passport to Health Service has developed and expanded to offer a range of physical activity interventions based at local leisure facilities and in other community settings. In October 2011, the Healthy Lifestyle Referral Hub launched, enabling anyone wishing to access stop smoking, healthy eating, weight management, lifestyle advisor and physical activity services to do so via one single referral form. Consequently, any referrals to the Passport to Health programmes go directly through the hub and are then processed by the Council’s Project Officers – Health. All programmes that form the Passport to Health Service aim to target sedentary individuals who also present with one or more other health related risk factor(s). The objective being to assist them in increasing their activity levels to help reduce their risk of coronary heart disease (CHD), and other diseases, and help combat the symptoms of mild to moderate depression and post-natal depression (PND). Individuals referred to the service are assessed and, where eligible, are offered a 12 week programme of exercise based on their needs. Costs for activities are heavily subsidised and all clients will attend pre- and post-exercise assessments to establish the impact the service has had on their activity levels and health risk. Any healthcare professional with access to an individual’s medical notes, who is able to complete the referral form in full, is able to make an official exercise referral. All other professionals are advised to recommend the programme by completing the top section of the hub referral form. Medical consent will then be requested by the Project Officers – Health. All referral consultants responsible for the safe and effective management, design and delivery of client exercise programmes are qualified in GP Exercise Referral and registered with the professional body REP (Register of Exercise Professionals) at Level 3 or 4.
5
Referral Guidelines
Referral Criteria
Appropriate Referrals Inappropriate Referrals** *Sedentary / Inactive ���� 60 mins moderate intensity activity per week. Aged from 16 years upwards All patients must be clinically stable Overweight/Obese Family History of CHD (1
st degree relative)
Smoker signed up to Support to Stop service Type 2 Diabetes BP/Cholesterol Risk Mild to moderate depression Post-natal depression Financial barriers Social barriers Physical/mental restrictions Carer commitments
Unstable angina, hypertension, diabetes
Post MI � 16 weeks, not attending Phase III Rehab Unstable or acute heart failure.
Acute Psychosis Acute viral illness Advanced osteoporosis, osteoarthritis or severe back pain Uncontrolled tachycardia � 100bpm at rest. Resting BP >180/100mmHg Pregnancy Claudication Palliative Care Please Note: Exercise referral instructors are not trained to accept the above high risk conditions as they do not hold additional qualifications to support these groups. Clients falling into the above categories would, therefore, not be appropriate and must not be referred.
*The GPPAQ may also be used to assess physical activity levels. Those patients scoring as ‘inactive’ or ‘fairly inactive’ would be appropriate. ** Anyone falling into the high risk category using the Irwin & Morgan Risk Stratification Tool (see appendix 2) would be inappropriate for referral. Medico-legal considerations If referred by a health practitioner:
• Clinical responsibility remains with the referrer.
• Responsibility for safe and effective management, design and delivery of the exercise programme passes to the exercise professional.
6
Operating Protocol for Referrers
1. Referrer identifies clients who are appropriate for referral
2. Client shows interest in participating and signs of readiness to change
3. Referrer completes referral form in FULL
4. Referral form is sent by post or fax to:
Healthy Lifestyle Service The Bungalow 11 Park Road
Keynsham BS31 1BX
Fax:0117 9872292
5. Project Officer - Health contacts patient to assess which activity pathway is most suitable based on their individual needs and arranges
appropriate activity pathway.
6. Referrer receives a feedback letter if client completes the programme.
5.Hub receive referral and send on to Project Officer – Health (where Physical Activity is ticked) for processing.
7
Operating Protocol for Referral Exercise Professionals
1. Project Officer - Health (POH) receives referral form from hub and contacts client to
assess their needs, assign activity pathway and advise on next steps.
2. Referral consultant receives paperwork and a call from the client and books an initial
consultation.
3. Client attends an initial consultation to discuss health status (using PAR-Q), lifestyle
issues and goals. An activity plan is established. Baseline measures are recorded and 6 and 12 week reviews are scheduled.
4. 6 week review is completed in order to monitor progress and make any necessary
exercise programme/activity pathway amendments.
5. At 12 weeks, clients attend an exit assessment to discuss a new 12 week action
plan and further goals are set. Baseline measures are repeated and clients are
signposted to any relevant activity opportunities.
A 3 month post-programme exit appointment is scheduled.
6. Client invited to 3 month post-programme exit appointment. Baseline measures may
be repeated and an evaluation form is completed to establish activity levels. (Clients referred with depression have
contact appointments at 14 weeks and 16 weeks before being discharged after 24
weeks)
Motivational Lifestyle
Programme
All clients are invited to attend a weekly course aimed at helping clients to establish healthier habits related to their physical and mental well-being.
8
Activity Pathways
Once an individual has been referred to the Passport to Health Service and has been contacted and needs assessed by the POH, one of the following activity pathways will be offered. Exercise for Depression – clients referred to manage their depression are prescribed enough exercise to benefit their mental well-being as recommended by the NICE guidelines. The pathways described above are offered based on assessment of their needs and preferences.
1 x 12 week Programme 2 x 6 week Group Programmes
Facility-based programme
• Bath Sports & Leisure Centre
• Keynsham Leisure Centre
• South Wansdyke Sports Centre
• Writhlington Sports
Community Activator programme
• 1-2-1 exercise programme delivery for 12 weeks followed by 1 x 6 week course or alternative
Give Us A Break Community Activator programme
• 1-2-1 exercise programme delivery for unpaid Carers
Group Cycling
Course
Group Fitness
Walking Course
Group Aquacise
Course
Group Circuit Class Course
OR
OR
OR
All clients formulate an activity maintenance plan during their exit
assessment.
9
Help Us to Help You
This document provides operational details about the Passport to Health Scheme. It is intended to help anyone involved with referring to the scheme understand the procedures involved when making a referral and using the service. If there is anything which could be made clearer or added to improve you understanding, please let the Project Officer - Health (POH) know by contacting:
Project Officer – Health Sport & Active Lifestyles Team
Bath & North East Somerset Council Lewis House (1st Floor)
Manvers Street Bath
BA1 1JG. Telephone: 01225 396427
Fax: 01225 396459 Email: [email protected]
11
Lifestyle Service Referral Form Service User Details (stick label) Referral Date: Lifestyle Issues
� Stop Smoking � Healthy Eating � Weight Management � please complete GP consent section below for Slimming on Referral � Physical Activity � please complete GP consent section below for exercise referral
Patient Consent
The reason for this referral has been explained to me. I want to participate and I give permission for this and any relevant information concerning my participation to be forwarded to the Lifestyle Service.
Signed:
Referrer Details
Name: Signature:
Place of Work: *Position:
* If you are not a medical professional please ensure your service user consents to liaison between the Lifestyle Service and your service user’s GP (GP details in top section). � Consent for liaison given (please tick)
If a GP/NURSE – please complete this section GP / PRACTICE NURSE CONSENT SECTION
Weight (Kg) Height (m) BMI BP (must be <180/100mmHg)
� GP Consent for Slimming on Referral (Midwife consent if patient is pregnant) I recommend that the above patient to participate in this programme. Their BMI is ≥28 with co-morbidities, or BMI ≥30 (>27 for BME patients).
� GP Consent for Passport to Health I am referring this individual for a prescribed programme of physical activity and can confirm that the service user is clinically stable and does not have any contraindications to exercise as indicated in the Guidelines for Referrers
Reason for Exercise Referral
CVD risk / mental well-being High Need Support Exercise for Depression
� Inactive (< 60 mins p/w) � BMI > 30 (or >27 for BME patients) � Family history of CHD � BP or cholesterol � Type 2 diabetes � Low mood / stress
� Inactive (< 30 mins p/w) � Financial barriers � Social barriers � Physical restrictions � Carer commitments
� Performing less than 45 minutes of physical activity 3 x p/w � Diagnosed mild/mod depression � Post natal depression
Current Medications: (print prescription)
Other relevant medical history/exercise recommendations: (print patient summary and attach)
Please return this form to the Lifestyle Service by ���� Fax on 01225 831498 or 0117 9872292 ���� Post to Health Improvement Services, The Bungalow, 11 Park Road,
Keynsham, BS31 1BX ���� or call 01225 831852 or 01225 831847 for more information or referral advice
NHS Number: Mr � Mrs � Miss � Ms � Other � Name: Address:
Postcode: DOB: Sex M � / F � Pregnant Yes �
Home No: Mobile No: Work No: Email: Preferred contact? � Home � Mobile � Work � Email Consent to leave message Yes � No � GP Name / GP Surgery (stamp)
12
Irwin & Morgan Risk Stratification Tool The Irwin and Morgan Risk Stratification Tool takes the form of a simple traffic light system, the categories of risk are demonstrated below: LOW RISK Overweight No complications High normal blood pressure
(130-139/85-89) not medication controlled
Deconditioned Due to age or inactive lifestyle Type 2 diabetes Diet controlled Older people aged >65 No more than 2 CHD risk factors and not at
risk of falls
Antenatal No symptoms of pre-eclampsia / no history of miscarriage
Postnatal Provided 6/52 check complete and no complications
Osteoarthritis Mild where physical activity will provide symptomatic relief
Mild bone density changes
BMD >1SD and <2.5 SD below young adult mean
Exercise induced asthma
Without other symptoms
Smoker One other CHD risk factor & no known impairment or respiratory function
Stress/mild anxiety Seropositive HIV
Asymptomatic
MEDIUM RISK Hypertension Stage 1 (140-159/90-99). Medication controlled Type 2 diabetes Medication controlled Type 1 diabetes With adequate instructions regarding
modification of insulin dosage depending on timing of exercise and warning signs
Physical disabilities No other risk factors Moderate OA/RA With intermittent mobility problems Clinical diagnosis Osteoporosis BMD -2.5 at spine, hip or forearm or _> 4
on Fracture index, with no history of previous low trauma fracture
Surgery – Pre and Post General or Orthopaedic. Not Cardiac. Intermittent claudication No symptoms of cardiac dysfunction Stroke/TIA >1 year ago. Stable CV symptoms. Mobile
no assistance required Asthma Mild (ventilator limitation does not refrain
submaximal exercise) COPD Without ventilator limitation but would
benefit from optimisation of respiratory Neurological Conditions system mechanics and correction of
physical deconditioning E.G YOUNG ONSET Parkinson’s Disease (stable); Multiple Sclerosis
Early symptomatic HIV Moderately diminished CD4 cells, intermittent or persistent signs and
13
symptoms e.g. fatigue, weight loss, fever, lymphadenopathy
Chronic Fatigue Syndrome Significantly deconditioned due to longstanding symptoms
Depression Mild to moderate
Fibromyalgia Associated impaired functional ability, poor physical fitness, social isolation, neuroendocrine and autonomic system regulation in disorders.
HIGH RISK Older people >65 years at risk of falls. Frail older people with osteoporosis and history of fracture
REFER DIRECT TO FALLS SERVICE (BMD) >-2.5 at spine, hip or forearm in the presence of one or more documented low trauma or fragility fractures). REFER DIRECT TO FALLS SERVICE
Unstable and uncontrolled cardiac disease
Claudication with cardiac dysfunction Orthostatic hypotension Fall SBP -20mg/Hg or DBP -10mg/Hg
within 3 mins of standing Stroke/TIA Recent (>3 months ago) Severe Osteoarthritis/Rheumatoid arthritis
With associated mobility
Type 1 or Type 2 Diabetes (Advanced)
With associated mobility
Moderate to severe arthritis With accompanying autonomic neuropathy, advanced retinopathy
COPD/emphysema With true ventilatory limitation AIDS With accompanying neuromuscular
complications severe depletion of CD4 cells, malignancy or opportunistic infection
Psychiatric illness/cognitive impairment/dementia
AMT score <8