Implementing an Innovative Lipid Management Technique Using siRNA LDL-C Lowering Therapy: Lessons Learned in an NHS Primary Care Practice With Worked Case Examples.

INTRODUCTION: The UK Government partnered with industry to tackle cardiovascular disease (CVD) in the first NHS population health agreement. The ambition was to prevent 150 000 strokes, heart attacks and dementia cases over the next 10 years with a new siRNA LDL-C lowering therapy (Inclisiran) delivered within Integrated Care Services by primary care to support a comprehensive approach to lipid management. Following the approval of inclisiran, and guidance published by the National Institute for Health & Care Excellence (NICE) on its use, this paper has been created by a UK general practice to share real-world observations of cases and the potential service benefits of rolling out this innovative drug treatment. The process of identifying patients at risk of atherosclerotic cardiovascular disease (ASCVD) and lessons learned from implementing in practice is also addressed. Workstreams were developed to rapidly roll out a low clinical burden enhanced lipid management program incorporating siRNA LDL-C lowering therapy into primary care practice. APPROACH/METHOD: (1) Multi-disciplinary team (MDT) education program based on freely available Academic Health Science Network (AHSN), National Institute for Health & Care Excellence (NICE), and commercial materials. (2) Automated searches using a software program were run to identify "at-risk" patients alongside manual case-finding in everyday clinics. (3) Patients were invited for review using multi-channel modalities. (4) Where appropriate, treatment was commenced after consent was obtained. (5) Automated recall systems are used to ensure follow-up; initially at 3 months, then every 6 months. DISCUSSION AND CONCLUSIONS: Enhanced lipid management as a secondary prevention measure is achievable in line with national guidance and objectives. The methodology and education/training processes used in combination with reconstructing the management process can help practice staff realize the program benefits, which in turn can lead to a shift in behavior where all staff embed manual case-finding of high-risk patients into everyday consultations and reviews; enabling rapid identification of eligible patients. Taking a multi-disciplinary, holistic approach to new initiatives reduces service burden, particularly for GPs. Leveraging resources from the AHSN and others removes additional training pressures often associated with new initiatives and provides a wealth of educational material to support primary care MDT upskilling.

How Remote Interventions Can Reduce the Impact of Disease-Related Malnutrition for Community Patients With Long-Term Conditions.

Nutrition is a critical part of health and development but over 3 million people in the UK are malnourished or at risk of malnutrition (93% living in the community). As part of a wider nutritional clinical review program across England, this specific pilot focused on proactive nutritional reviews within 1 rural practice, to explore how exacerbation of illness for patients with long-term conditions may be prevented and quality of life improved through the avoidance of malnutrition; identified through the timely delivery of holistic clinical assessments; and managed with nutritional interventions that patients actively engage with. These objectives were of particular significance in 2020 due to the challenges posed by Covid-19 in the delivery of healthcare. Within the pilot activity, a selection of patients at the practice were identified based on predetermined criteria. The intervention was delivered remotely by a clinical pharmacist. Two methods of communication with patients were explored during the pilot-initially communicating by letter, and latterly by telephone call. From a registered patient population of 6138, 59 of these patients were flagged to the practice for assessment as required and 102 patients were prioritized for remote assessment. Following a notes review, 60 patients were contacted via telephone with no action for 39 patients; 16 patients agreeing to a "food-first" approach; and 5 patients prescribed ONS. Results from the pilot and wider program activity demonstrate that patients willingly engaged in a proactive approach to remote assessments when using appropriate communication channels. It has also demonstrated that through guidelines adherence resulting in more appropriate prescribing, there are significant cost savings to be made through the implementation of remote nutritional assessments in primary care. Further research is required to address the system-wide benefit that these reviews and the identification of adults at risk of malnutrition could deliver.