Patient and public involvement and engagement in CVDACTION

CVDACTION is a smart data tool developed by UCLPartners to help GP practices transform the prevention of cardiovascular disease (CVD).

CVDACTION is being piloted and evaluated in ten demonstrator sites in London and three Integrated Care Boards (ICBs) across England. 

CVDACTION was piloted in three Primary Care Networks (PCNs) in North West London to help deliver preventative care for CVD. The dashboard is used by GP practices to identify patients at increased risk of CVD so they can be proactively contacted to have blood pressure checks and discuss necessary treatment options.

The dashboard also includes resources for teams to support patient education, self-management and behaviour change. ICHP were brought into CVDACTION to support NW London PCNs with patient and public involvement and engagement (PPIE). Through PPIE we can better understand how patients experience the care pathway. Insights gathered can inform how to increase engagement with patients, develop a better pathway experience and ultimately improve heart health in NW London. 

ICHP lead the PPIE by working closely with PCN staff. We held an initial meeting with PCNs to discuss their challenges to patients engaging with blood pressure checks and to refine the PPIE focus areas, delivery method and recruitment.  

Overall, the three PCNs wanted to explore similar themes with their patients. PPIE focus areas were:  

• Barriers to patients submitting readings 
• Experiences of the pathway
• How to tailor communications and messaging to explain why blood pressure is important 
• What lifestyle support/information patients want and how they’d like to receive this 
• What information patients want if they are advised to start new medication 
• What support helps patients to take-up/adhere to medication and improve compliance (especially around statins) 

ICHP provided PCNs with information to share with patients who had been identified through CVDACTION across all GP practices. The information detailed the engagement aims and how people could express interest by getting in touch with ICHP. We wouldn’t have been able to access these patients without the PCNs, therefore requiring us to collaborate closely and maintain regular contact. In total, ICHP engaged with 25 patients through individual interviews as well as online and in-person focus groups. 

ICHP also joined one PCN team (Neohealth) at a community outreach event on Portobello Road, where a stall was set up offering free blood pressure checks and health advice. Whilst the public waited for their turn, they could engage with ICHP about their barriers to visiting their GP and what health information they’d like to help manage their blood pressure.   

ICHP presented the key findings and insights gathered to each PCN: 

• A high number of patients had to be contacted to achieve a suitable number of people expressing interest in attending a focus group or interview. This required continued effort from the PCN to support recruitment. 
• There are some limitations to findings as many patients did not have direct experience of the pathway. 
• Patients would welcome a proactive phone call about their blood pressure but not all felt that this was happening. Most patients engaged with a text message, although they could feel impersonal. There was uncertainty around the follow up process. Personalised language and clearer communication on the process would improve patient experience. 
• Written health information is helpful, but people appreciate an in-person conversation to ask questions. Patients have lots of questions about their blood pressure and would like to better understand how to manage their health. Support and advice on managing blood pressure through lifestyle modifications that are convenient within busy schedules is helpful. 
• To improve perception and uptake of statins, tailored conversations around risks of side effects and individual benefits of medication are needed, as well as reassurances around having frequent medication reviews and option to change medications.   

PCNs were grateful and receptive to the feedback, which validated their experiences on the ground and provided them with further understanding of their patients’ needs. 

ICHP were also able to suggest actions for PCNs to improve patient experience. These included: 

• Tailored initial communication when requesting readings 
• • Explaining the importance of monitoring blood pressure for the individual and if/when they will be followed up 

• Accessible information on managing blood pressure and benefits/risks of medication 
• • Including written information and in-person opportunities to ask questions
  • Personalised diet/exercise plans  

• Report back to participants and all patients on how their involvement has influenced the project e.g. “You said, we did” 

UCLP will be evaluating the overall project, including the PPIE element, with all PCNs across the country with the hope of scaling CVDACTION.