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New research suggests that taking a more tailored approach to managing high levels of blood cholesterol in patients could improve cardiovascular health in areas of deprivation.

The work was led by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) in collaboration with Health Innovation North East and North Cumbria (HI NENC). The research has been published in the Sage Journal of Primary Care and Community Health.

Hyperlipidaemia is a high level of cholesterol or triglycerides in the blood – and contributes to cardiovascular disease (CVD) risk. Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels. It’s usually associated with a build-up of fatty deposits inside the arteries and an increased risk of blood clots.

It can also be associated with damage to arteries in organs such as the brain, heart, kidneys and eyes.

CVD is one of the main causes of death and disability in the UK, but it can often largely be prevented by leading a healthy lifestyle.

People living in areas of deprivation are more likely to experience high blood cholesterol and are 20 percent more likely to develop cardiovascular disease compared to others.

People living in the most deprived areas can also face higher barriers when it comes to accessing good healthcare. This happens for many reasons – including complex and challenging life circumstances, lower levels of awareness around health management, language or cultural barriers, and difficulties attending appointments.

These factors can make managing cholesterol more challenging in communities experiencing socioeconomic disadvantage, increasing the risk of cardiovascular disease.

Researchers from the NIHR ARC NENC and HI NENC worked together to analyse how primary care practices in areas of deprivation were supporting patients with lipid management.

The research team interviewed clinicians from ‘Deep End’ practices in the North East and North Cumbria – which are GP practices serving some of the most socioeconomically disadvantaged communities in our region – to identify barriers and opportunities to improve care delivery.

Five key themes emerged from the interviews. These were:

• Many patients had complex and multiple health needs, which meant clinicians were working with competing priorities when caring for these patients.
• There was limited access to follow-up services and supporting services for patients.
• The ability for clinicians to be flexible and work beyond guidelines – clinicians felt that more flexibility would be beneficial.
• High patient workloads with inadequate staff support can be a constant challenge in Deep End practices.
• The need to recognise patients’ situations and clinicians’ efforts in deprived communities. To address medical and social needs, clinicians suggested a systematic integrated approach with accessible services provided by a multidisciplinary team.

The findings led to a range of recommendations, including that a more tailored and flexible approach to cholesterol management in primary care could improve health outcomes in communities experiencing socioeconomic disadvantage and reduce the risk of cardiovascular disease.

These recommendations have since been fed back to inform a national lipid management programme, including the key recommendation that primary care providers in areas of deprivation should have more flexibility and support for lipid management in their communities.

Dr Sarah Sowden, Senior Clinical Lecturer and Public Health Consultant from Newcastle University and the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) was part of the research team. She said:

“We already know that people living in some of our most deprived areas face higher barriers when it comes to accessing good healthcare for many reasons, including complex and challenging life circumstances. These factors can make managing cholesterol difficult, worsening health inequalities”

“Our findings recommend that a more tailored and flexible approach cholesterol management in primary care could improve health outcomes in communities experiencing socioeconomic disadvantage and reduce the risk of cardiovascular disease – which can lead to serious health outcomes such as heart attacks.

“The work also recognises that this can be difficult to achieve when GPs and primary care clinicians are under a lot of pressure – dealing with higher numbers of patients, often presenting with multiple and complex health issues. Addressing underfunding and understaffing in primary care is crucial if we want to achieve fairer health care for patients in these areas.”

Developing a more flexible solution

The research highlighted that it was often difficult for patients to attend a GP surgery for frequent blood tests as part of their lipid management programme.

This led to the development of a pilot to make cholesterol testing more accessible.

The aim of the pilot was to identify people at risk of heart attacks and strokes using an innovative cholesterol test. This allows testing for lipids testing to move out of GP surgeries, dramatically increasing access to testing which in turn aims to prevent more people from developing cardiovascular disease.

The North East pilot focussed on increasing access to cholesterol testing outside of a traditional GP surgery environment, including at-home, on the high street, workplaces and in other community settings.

High risk patients in deprived communities and those who are less engaged with GP services across the region were a key priority during the pilot.

HI NENC and ARC NENC secured £276K of funding from the System Transformation Fund (STF) to develop an industry partnership with PocDoc – who offer technology that allows a cholesterol test at any location.

Since then, over 5,000 patients in the North East have undertaken a cholesterol check using PocDoc. As a result, 30 percent of patients were referred to their GP with a referral letter for further healthcare advice, potentially leading to earlier identification and treatment of serious illness.

Professor Julia Newton, Medical Director at HI NENC, added:

“Cardiovascular disease is the leading cause of death in the North East and North Cumbria, with deprived communities less likely to engage with preventative services despite being at higher risk. This highlights deep-rooted health inequalities in the region and emphasises the need to support these communities in understanding their risks.

“I’m pleased that our research is already influencing local services. We found that accessing lipid management services often requires multiple GP visits for blood and other routine tests, creating time and cost barriers. This insight led to the development of a community cholesterol testing pilot in Middlesbrough, making it easier for people to understand and manage their cardiovascular health in a setting and language that is familiar and accessible to them. Following its success, we are delighted to now be scaling this initiative across the region.”

You can read more about this work, here.

Read the full journal article here.