Northamptonshire team start successful community health screening programme

The Population Health team from the Northamptonshire Integrated Care Board (ICB), Northamptonshire Healthcare NHS Foundation Trust (NHFT), Northamptonshire Black Communities Together (NBCT), Graphnet Health and eight community partners have been collaborating to address health inequalities experienced by Black communities living in areas of high deprivation in Northampton town and central Wellingborough. The collaborative team have been running a Healthy Heart Campaign to opportunistically test for undiagnosed Atrial Fibrillation (AF) and Hypertension (HTN) within Black African, Black Caribbean and South Asian communities, offering pathways to diagnosis and treatment, as well as heart health education. The innovative approach to testing has enabled Community Champions from the Northamptonshire Black Communities Together to deliver the testing within local community venues, alongside having the use of a hand-held Docobo virtual monitoring device (Careportal), to test for AF, as well as record other participant information.

So far, the project has tested 426 people, and has alerted the team to 5.9% of these people with potential AF and 32.4% with high or very high blood pressure.

We have found this project to be very helpful in raising awareness of Atrial Fibrillation and Hypertension, and we have received positive feedback from the communities who attended the sessions. This approach has been innovative in engaging Community Champions from different Black communities who have reach and can engage people so that more people can gain access to screening and information.

Pratima Dattani, CEO of Support Northamptonshire hosting Northamptonshire Black Communities Together.

This programme is part of the national Innovation for Healthcare Inequalities project (InHIP), commissioned by Health Innovation East Midlands.

How does the opportunistic testing work?

Community groups set up opportunistic testing events within their community. Community group leaders and Champions from Northamptonshire Black Communities Together have been trained by Graphnet and the clinical team, on how to use the remote monitoring devices. The AF test itself involves participants holding a hand-held device for 30-seconds, allowing it to capture a single lead ECG reading. The Docobo Careportal captures the information, alongside blood pressure readings and other participant details and passes this information back to a team of clinicians, who are able to read and interpret the results. Where necessary, the clinicians advise the participants further by phone and link them with their GP.  The clinical team are also able to check the blood pressure readings against the recorded actions that were recommended by the Community Champions to ensure they are correct. At each testing event, 20% of those people tested are also asked to complete an ‘Attitudes Questionnaire’ which captures lifestyle details, their engagement and registration with GPs, vaccination information and some of the wider determinants relevant to health and lifestyle. 

Results so far

426 combined Atrial Fibrillation and Hypertension tests completed, of which:

• 5.9% were query Atrial Fibrillation
• 32.4 % were query high or very high blood pressure
• 4.5% were other cardiac issues

Tim Lloyd, Population Health Officer, Northampton ICB said:

Circulatory disease is one of our biggest challenges within Northamptonshire. On top of that, we have communities that are much more at risk of developing more serious complications. So, this project is enabling us to work directly with the community, encouraging community leaders to recruit community champions who, with training, are able to deliver opportunistic testing for both AF and HTN.  This community led approach will hopefully encourage more people from within these minority communities to engage more directly.

We are learning a lot from this InHIP project, and we hope that our final analysis and evaluation report will support future recommendations for service planning, design and delivery. This approach is a real innovation and coupled with the testing and data capture potential of the Docobo device it could support future community-based engagement.  

Pratima Dattani, CEO of Support Northamptonshire hosting Northamptonshire Black Communities Together says:

We want to tackle health inequalities and improve health and wellbeing for Black communities, and we have found this project to be very helpful in raising awareness of Atrial Fibrillation and Hypertension, and we have received positive feedback from the communities who attended the sessions. People have said that they welcomed the chance to have screening, and in fact, the demand for screening has exceeded the initial plan, which shows how useful it has been. This approach has been innovative in engaging Community Champions from different Black communities who have reach and can engage people so that more people can gain access to screening and information.   

Paula Love, Lead Nurse for Integrated Care Transformation and Interim Lead for the remote monitoring Virtual Clinical Care Team Hub says:

Through the use of clinical innovation, the Docobo Telehealth system has emerged as a powerful tool for community screening in Northamptonshire. As a class 11 medical device, it is helping to bridge inequalities in fostering proactive healthcare in the local communities where it is needed most. Through this collaboration, the clinical screening team has been able to extend the reach of clinical assessments for Atrial Fibrillation and Hypertension by empowering local community champions to deliver accessible screenings that paves the way for a healthier future. This clinical model could significantly contribute to the crucial first line of defence in identifying these critical health issues, allowing for timely interventions that can prevent complications, hospitalisations and improve the overall health and well-being of individuals.

Adrian Flowerday, MD of Docobo remote monitoring says:

It is great to see how using population health and remote monitoring can identify people who might be at risk of CVD, AF and strokes. With this project, we are seeing real evidence of how we can ensure digital equality and support, especially within communities that face greater inequalities in health outcomes.

Futures

The project team, alongside the Focus Group facilitators from the University of Northampton intend to use the testing data, questionnaire feedback and focus group engagement to create a detailed evaluative report which aims to influence future approaches to the design and delivery of health care interventions in the future.  Further results will be published later in 2024.

You can find out more about the project here.

[1] Evidence reveals that AF and HTN disproportionally affect a greater proportion of people from certain Black and Asian communities (Black African, Black Caribbean and South Asian), while individuals from areas with the highest deprivation have an approximately 12% higher risk of developing AF, and subsequently they can develop a 26% higher fatality than patients living in the wealthiest areas. Cardiovascular disease overall is the leading cause of death nationally in the UK, and in ethnic minority groups, causing 24% of all deaths in England and Wales in 2019. It is a significant contributor to inequalities in life expectancy. Up to 80 per cent of premature deaths from CVD are preventable through public health initiatives.