Transcript Document

Local Awareness and Early
Detection Initiative (LAEDI)
Dr Nicola Robinson
MacMillan GP
16/07/2015
Workshop Aims
1.
To understand why early detection is important
2.
To look at ways to increase early detection – Local Awareness and Early
Detection Initiative (LAEDI)
Where you can help
3. To consider the challenges to early detection and how to address them
4. To identify other conditions where LAEDI could help with early detection
Why early detection?
 Late diagnosis of cancer accounts for up to 10,000 avoidable deaths per annum
 Up to 100,000 years of life lost per annum in England from treatable cancer
 23% of all cancers diagnosed via emergency presentations
 Treatment costs 4 times higher with late diagnosis
 By 2021, 65% increase in costs of treating cancer (to £13.1bn) unless we do
something different (RCGP)
Ref: NHS Outcomes Framework 2011
Reduced years lost
The Pathogenesis of Bowel Cancer
Dukes’ Stage
A
B
C
‘D’
Polyp
>50 years - 1 in 4 have polyps
Survival 5 years after treatment
1 in 10 change to invasive cancer
93%
77%
48%
7%
With permission from Professor S Halloran
Bowel Cancer Screening Programme
England’s Programme
2 yearly (2006 – Sept 2013)
10m
13m
Dukes
Stage
Symptomatic
England
Screening
A
11%
36%
B
35%
40%
C
26%
20%
‘D’
29%
4%
Early Cancer
Detection
Test Kits Out
Test Kits In
+ve Screens
Colonoscopies
Cancers
Advanced Adenomas
Polypectomy rate
210,000
17,114
19,384
48%
14.5m
20.2
million
11.6 million
214,000
Cancer
Prevention
Local Awareness and Early Detection Initiative
Peer to peer
support
Supporting GPs
to make best use
of all available
resources
LAEDI
Practice
specific data
review
MacMillan GP to GP education visit
Wessex region (% change per practice, 2012 to 2013)
LAEDI
intervention
results in
improved
uptake and
accuracy of
diagnosis
12
10
8
6
4
2
0
% increase
-2
%
increase
bowel screening (% of eligible detection rates (% of cancer
population)
diagnosis via the 2ww oathway
%
increase
Conversion Rates (% of 2ww
referal found to be cancer)
Visited Practice Average
England
Early detection: the challenges
Bowel cancer screening seems to work well…
…but only for those who do the test!
Those who need the test most…
… are typically those who don’t do it!
I need to encourage patients to take the test…
…they are my patients but…
 I don’t have a list of those who don’t do the
test.
 I don’t have the time to see, speak or write to
them.
 I mustn’t bully, coerce or persuade them.
It must be their choice!
Southern Hub
Prevalence uptake per invitation episode
by social deprivation (IMD)
80
% Uptake (definitive result)
70
60
50
1st IMD quintile
2nd IMD quintile
40
3rd IMD quintile
4th IMD quintile
30
5th IMD quintile
20
10
0
1st invitation uptake
2nd invitation uptake
3rd invitation uptake
Cumulative uptake
Uptake in
Portsmouth
Response
No
Response
66.4%
33.9%
The challenges
55% on average engaged at the start, benefit of LAEDI GP visit, and a further
10% engaged through reminder letter
What about the remaining 35%??
•
•
•
•
Group Discussion
How can we raise awareness and uptake amongst those patients who haven’t
responded to LAEDI?
Can we do more to raise awareness with GPs, do rates of early diagnosis vary for
different age groups eg younger patients diagnosed later?
How can patients be motivated and empowered to make lifestyle changes?
What other areas could benefit from roll out of the LAEDI approach?
Wessex Strategic Clinical
Networks and Clinical Senate
Early detection & LAEDI: where next?
Next steps, roll out LAEDI to:
 Acute Kidney Disease (AKI)
 1.8m people diagnosed in England
 a further 1m undetected cases
 45,000 premature deaths per year (Ref: NHS Kidney Care)
 Serious Mental Illness (SMI)
 People with SMI die on average 20 years earlier
 1 in 3 of avoidable deaths in England per annum affected by SMI Ref: NHS
Outcomes Framework 2011
 Where else could we have the greatest impact on years of life lost through the
application of LAEDI?
Reduced health costs
Acute Kidney Injury (AKI)
• NHS spent £1.64bn treating renal problems in 2009-10, up 23% on previous year
• AKI costs more per year than skin and lung cancer combined
In 2009-10:
• AKI spend
= £434m to £620m
• Lung cancer spend = £276m
• Skin cancer spend = £115m
• Prevention of 30% of AKI cases would save £130- £186m per year
• AKI patient bed days averaged 18 days compared to 7 days in non-AKI patients
• Reducing AKI by 10% would save 5,000 bed days
Ref: The Economic Impact of Acute Kidney Injury, Marion Kerr, HSJ, 27 Jan 2011
With permission from Dr Graham Watkinson
Consultant in Public Health
Feedback & Key Actions
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