Tailoring lipid management interventions to reduce inequalities in cardiovascular risks and improve outcomes in deprived communities
This study aims to develop a tailored intervention aiming to optimise lipid management in primary care settings to help reduce inequalities in cardiovascular disease (CVD) risks and improve outcomes in deprived communities. It is a joint project between the NIHR ARC North East and North Cumbria, and the Academic Health Science Network (AHSN) North East and North Cumbria.
This work has been funded by successful bids to the Beneficial Changes Network, the AAC System Transformation fund and NHS England’s Innovation for Healthcare Inequalities Programme (InHIP). These programmes aims to address local healthcare inequalities experienced by deprived and other under-served populations.
Context of the study
Hyperlipidaemia (a high level of cholesterol or triglycerides in the blood) contributes a significant proportion of modifiable cardiovascular disease (CVD) risk, which is a condition that disproportionally affects disadvantaged socioeconomic communities, with death rates in the most deprived areas being four times higher than those in the least deprived.
Elevated levels of blood lipids represent a major risk factor for the development of coronary heart disease and other diseases including stroke, transient ischaemic attack (TIA) and peripheral arterial disease.
CVD is also a condition that is strongly associated with health inequalities and disproportionally affects disadvantaged socioeconomic communities. People in disadvantaged socioeconomic groups experience a higher prevalence of CVD events but poorer outcomes and premature mortality, leading to the fact that people in the most deprived areas in England are four times more likely to die prematurely than those in the least deprived. Heart disease-related mortality is the single largest contributor to the life expectancy gap between the most and least deprived.
In addition, those living in socioeconomically disadvantaged neighbourhoods are found to have poor engagement with preventive health services, even though they are likely to benefit from screening and early treatment. This may lead to an exacerbation of existing health inequalities. The National Institute for Health and Care Excellence (NICE) guidance has recognised socioeconomic status as an additional factor that contributes to CVD risk.
The North East of England is consistently ranked as having the highest poverty levels and the lowest health outcomes in England. Scotland has established a programme to support general practices caring for the most deprived communities (the ‘Deep End’ project).
In 2020, funding was granted from the North East and North Cumbria Integrated Care System (NENC ICS) Prevention strand to establish and co-design a Deep End network for the region. The Deep End NENC network consists of 38 practices that fall into the 10% most deprived practice populations in England.
This study will look at patient information from Deep End practices in the North East of England, and include interviews with staff and patients from Deep End practices.
This study involves a mixed methods approach, including:
- A rapid review and logic model to examine relevant interventions and associated effects.
- Quantitative assessment and comparison of CVD risk management for deprived with non-deprived populations to England overall, before and during COVID-19.
- Interviews with health professionals who are involved in the organisation and delivery of routine lipid management to deprived populations, to understand their needs and challenges for the implementation and delivery of current lipid management.
- Intervention development using evidence generated, which will be reviewed and assessed by the project advisory group to reach a consensus.
- Training and skills development materials will also be developed as needed.
Read the study protocol: Tailoring lipid management interventions to reduce inequalities in cardiovascular disease risk management in primary care for deprived communities in Northern England: a mixed-methods intervention development protocol – BMJ Open, July 2022
This study is currently underway.
Find out more
For more information please contact Professor Julia Newton, AHSN NENC – [email protected]
Related publications: Cardiovascular-related conditions and risk factors in primary care for deprived communities before and during the COVID-19 pandemic: an observational study in Northern England – BMJ Open, November 2022
Further work linked to this project
Overcoming the barriers to accessing lipid management
The qualitative interviews that have taken place as part of this work have subsequently informed a range of other projects. One of the challenges highlighted by patients is the need to have a blood test as part of the their lipid management programme, and this can sometimes require multiple visits to the GP surgery with time and cost implications for individuals.
In September 2022, the System Transformation Fund (STF) offered an opportunity to deliver a project to overcome some of the barriers to accessing lipid management in disadvantaged communities, and the ARC NENC secured £276K of funding in collaboration with the AHSN.
This funding has enabled the development of an industry partnership (via the AHSN) with a company called POCDOC who have developed technology that allows a cholesterol test at, or near to, a person’s home. The technology is based on a lateral flow test and a linked mobile app.
We are now working to identify people linked to ‘Deep End’ practices in areas of blanket deprivation who have failed to engage with a CVD health check – and offer them a chance to perform a POCDOC test.
In parallel, POCDOC also applied for a Small Business Research Initiative Grant (SBRI) which will provide additional testing capability in primary care – but also extending this into community pharmacies and corporate settings.
Understanding the challenges faced by the South Asian, Afro-Caribbean and other disadvantaged populations
As part of the work funded by the NHS InHIP programme, a project is underway that focusses on areas in Middlesbrough where there are high levels of deprivation and associated CVD.
As part of this project we are working to understand the challenges faced by the South Asian, Afro-Caribbean and other disadvantaged populations in accessing an annual CVD check. This project builds upon our initial findings from the lipid management work.