Chronic Disease

What is pre-diabetes?

Some patients have a blood sugar level which is higher than normal but not high enough to be called diabetes. This is called pre-diabetes and can be identified by blood sugar (glucose) tests. Technically, pre- diabetes may result from one of three conditions called Impaired Fasting Glycaemia, Impaired Glucose Tolerance and Increased Glycated Haemoglobin. However, the effect is the same – it means raised blood sugar and a higher risk of getting diabetes and heart disease.

Making changes to your lifestyle can delay or even prevent the development of type 2 diabetes and reduce the risk of heart disease too. The US Diabetes prevention trial has indicated that mild-moderate weight loss (5% of body weight) and exercise(30mins of brisk walking 5 times a week) may reduce your risk by 58% of developing diabetes whereas being prescribed metformin(antidiabetic medication) only reduces your chances by 33%. The type of diet is also important as eating less saturated fat and low glycaemic index foods consisting of complex  carbohydrates (i.e brown bread, pasta etc) rather than simple carbohydrates (e.g chocolates, buiscuits) result in lower excursions of your sugar levels post meal and lower risk of progression to diabetes. Stopping smoking is also paramount.

Out of 100 people with pre-diabetes . . .

Risk of diabetes if Risk reduces with no action taken lifestyle change

People who will go on to get diabetes are shown in red

This is because being overweight and inactive increases both the risk of diabetes and related diseases such as hypertension and heart disease. (genes also play a part in prediabetes, or being on steroids).
People with pre-diabetes do not usually have any symptoms. It can be diagnosed by your practice nurse or general practitioner using a blood test.

Novel Practice Pre Diabetes Service
We are delighted to introduce a practice pre-diabetes service in order to prevent patients from progressing to diabetes and achieve the best possible care for our patients. It is paramount that patients with pre diabetes have a yearly check up of their sugar levels and other risk factors.
Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse and doctor for an annual review going through a checklist with you. Please make sure you have your blood tests and urine test before coming to see the nurse.

Annual Review Appointments
Your very first review appointment needs to be booked directly by you at the aforementioned clinic.
Following review by the nurse and doctor, an appropriate follow up will be offered.
We think this service will be well-received,and welcome any feedback from your experiences.
Please inform your personal doctor to request your blood and urine test online and then visit a laboratory of your choice to have your tests done.

Further information

Useful websites:

American Diabetes Association – http://www.diabetes.org/?loc=logo This American website has very good detailed information to help you learn about pre-diabetes, ideas about exercise, recipes, diet and losing weight.

Diabetes UK website – http://www.diabetes.org.uk – General information on diabetes with summaries of recent research, detailed information on eating well, getting active, meal planning (see under ‘managing diabetes’). Also links to local diabetes websites.

Losing weight – http://www.nhs.uk/LiveWell/loseweight/Pages/Loseweighthome.aspx – Helpful advice and tips on how to lose weight and maintain a healthy, balanced diet.

Diabetes books – A good way to find a range of books is to search book-selling websites. An example is “Diabetes: A Practical Guide to managing your health”, by Rosemary Walker and Jill Rodgers (2004), published by Dorling Kindersley and Diabetes UK: An excellent and readable guide.

What is hypertension?

Hypertension is high pressure of blood in your arteries. It is recorded as two numbers, eg. 120/80. The top number (systolic) is the pressure in the arteries when the heart contracts. The bottom number (diastolic) is the pressure in the arteries when the heart rests between each heartbeat. High blood pressure is a reading that is 150/90 mmHg or above.

A lot of patients ignore their blood pressure as high blood pressure itself has no symptoms. It is however a strong risk factor for developing a cardiovascular disease (such as a heart attack or stroke), eye and kidney damage.
In general, the higher your blood pressure, the greater the health risk. But, high blood pressure is just one of several possible risk factors for developing a cardiovascular disease. Others include smoking, alcohol, high cholesterol, diabetes, age, male gender, strong family history, sedentary lifestyle, ethnic origin, obesity, amongst others.

Apart from taking your prescribed medication, it is important to make modifications to your lifestyle where required, eg: weight loss, stop smoking, exercise, eating a healthy diet, lowering salt and caffeine, limiting alcohol intake

Novel Practice Hypertension Service

We are delighted to introduce a practice hypertension service in order to prevent patients from progressing to complications and achieve the best possible care for our patients. It is paramount that patients with hypertension , have a yearly check up to review their BP level throughout the year (at least every 3 months) and other risk factors.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for an annual review going through a checklist with you. Please make sure you have your blood tests and urine test before coming to see the nurse. It is also useful to record your BP at home if you have a machine as sometimes in the presence of White Coat Hypertension (i.e BP going up when visiting doctor) may be more indicative of your real BP.

Annual Review Appointments

Your very first review appointment needs to be booked directly by you at the aforementioned clinic.

Following review by the nurse and doctor, an appropriate follow up will be offered.

We think this service will be well-received,and welcome any feedback from your experiences.

Please inform your personal doctor to request your blood and urine test online and then visit a laboratory of your choice to have your tests done.

Further information

Feel free to ask your Personal doctor or nurse if you have any questions.

There are also a number of helpful websites online:

http://blog.ohiohealth.com/wp-content/uploads/2016/11/12_09-DASH-Diet-dbt.jpg

http://patient.info/health/high-blood-pressure-hypertension http://patient.info/doctor/management-of-hypertension

http://patient.info/doctor/management-of-hypertension

http://www.nhs.uk/Conditions/Blood-pressure-(high)/Pages/Introduction.aspx http://bhsoc.org/latest-guidelines

http://bhsoc.org/latest-guidelines

What is asthma?

It is a chronic disease that causes your airways to become inflamed, making it hard to breathe. There is no cure for asthma. The best way to manage asthma is to avoid triggers, take medications to prevent symptoms and prepare to treat asthma episodes if they occur.

Novel Practice Asthma Service

We are delighted to introduce a practice asthma service in order achieve the best possible care for our patients. It is paramount that patients with asthma have a yearly check up of their asthma, even if it is well controlled. This is of paramount importance as 50% of patients do not realise that their asthma is not well controlled

Evidently patients who have uncontrolled asthma require an urgent appointment with their personal doctor.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we offer systematic reviews every year with the nurse . After that you will see the doctor on the same day. Please make sure you take your inhaler and preferably a printable asthma action plan (see below).

Annual Review Appointments

Most people go for an asthma review once a year. Asthma guidelines recommend this as an important way to help you stay on top of your asthma symptoms.

Usually your Primary care doctor/centre will invite you for an annual asthma review. However due to the inability to recall on the GESY system for your first appointment you need to book it yourself. Following the first appointment you will be invited for a recall. If your surgery hasn’t invited you for recall, then you can book an appointment yourself.

If you have difficult or severe asthma you need to go for an asthma review more often.

If you’re having asthma symptoms, don’t wait for your annual check. Give your surgery a call and get seen sooner.(see below for further information)

We think this service will be well-received, and welcome any feedback from your visit.

This is a good opportunity to talk through what you can do to lower your risk of an asthma attack, for example using your preventer regularly, or stopping smoking, or losing any excess weight.

Furthermore we will review your asthma medication to make sure they’re still working for you.

If you’ve had no symptoms and haven’t needed your reliever inhaler for three months your Personal Doctor can look at cutting down your asthma medicines.

Apart from annual review make sure you see your Personal doctor about your asthma

• within 24 hoursif asthma symptoms have been getting worse, you need to use your reliever inhaler three or more times a week, or you’ve had an asthma attack
• within two working daysif you’ve had to go to hospital with an asthma attack
• within four to eight weeksif your prescription has changed
• after 12 weeksif you’ve had no symptoms. You should be on the lowest dose of medicine needed to keep you free of symptoms. Depending on your triggers and the pattern of your symptoms, you and your Personal doctor can talk about keeping you on the same dose of medicines or reducing your dose
• if you have seasonal triggers like hay fever. Try going the month before your hay fever usually starts. Managing hay fever symptoms is an important way of managing your asthma. Your Personal doctor may also increase your asthma treatment beforehand to provide extra protection

Further information

Inhaler technique

https://www.youtube.com/watch?v=5gPyNNXP-wA

Printable asthma action plan

What is COPD?

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. The main symptom of COPD is an inability to breathe in and out properly. This is also referred to as airflow obstruction.

COPD usually results due to smoking thus patients are inherently at increased risk of cardiovascular disease as well. Patients frequently have exacerbations sometimes needing antibiotics and oral steroids. Thus it is important for patients with frequent exacerbations to have a rescue pack of antibiotics and steroids at home (please discuss with your personal doctor). Signs you are having a COPD exacerbation are being more breathless, increasing amount or change in colour of sputum, fatigue. A visual guide to this is attached below as a COPD action plan you should have at all times for reference.

Novel Practice COPD Service

We are delighted to introduce a practice COPD service in order achieve the best possible care for our patients. It is paramount that patients with COPD have a yearly check up their asthma even if it is well controlled.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we offer systematic reviews every year with the nurse. After that you will see the doctor on the same day. Please make sure you take your inhaler and preferably a printable COPD action plan (see below).

Annual Review Appointments

Usually your Primary care doctor/centre will invite you for an annual COPD review. However due to the inability to recall on the GESY system for your first appointment you need to book it yourself. Following the first appointment you will be invited for a recall. If your surgery hasn’t invited you for recall, then you can book an appointment yourself.

If you have severe COPD you need to go for an asthma review more often.

We think this service will be well-received, and welcome any feedback from your visit.

Further information

Inhaler technique

https://www.youtube.com/watch?v=5gPyNNXP-wA

Printable COPD action plan

What is chronic kidney disease?

Chronic kidney disease (CKD) is a long-term condition where the kidneys don’t work as well as they should.

It’s a common condition often associated with getting older. It can affect anyone, but it’s more common in people who are black or of south Asian origin.

CKD can get worse over time and eventually the kidneys may stop working altogether, but this is uncommon. Many people with CKD are able to live long lives with the condition.

Novel Practice CKD Service

We are delighted to introduce a new way of delivering our practice CKD service in order to achieve the best possible care for our patients. It is paramount that patients with CKD have a regular check-up particularly of their eyes and their kidneys, in order to prevent complications.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for an annual review going through a checklist with you. Please make sure you have your blood tests, urine test and eye check before coming to see the nurse.

Annual Review Appointments

Your very first review appointment needs to be booked directly by you at the aforementioned clinic.

Following review by the nurse and doctor, an appropriate follow up will be offered.

We think this service will be well-received,and welcome any feedback from your experiences.

Please inform your personal doctor to request your blood and urine test online and then visit a laboratory of your choice to have your tests done.

Further information?

Kidney Care UK: chronic kidney disease

National Kidney Federation: what is kidney disease

Kidney Research UK: chronic kidney disease

What is chronic heart failure?

The term “heart failure” makes it sound like the heart is no longer working at all and there’s nothing that can be done. Actually, heart failure means that the heart isn’t pumping as well as it should be.

Chronic heart failure results in significant morbidity and mortality thus patients with heart failure need regular monitoring at least every 6 months.

Novel Practice CHF Service

We are delighted to introduce a new way of delivering our practice chronic heart failure service in order to achieve the best possible care for our patients. It is paramount that patients with heart failure have a regular check-up as mentioned above.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for an bi-annual review going through a checklist with you. Please make sure you have your blood tests, urine test and eye check before coming to see the nurse.

Annual Review Appointments

At the beginning(first ever appointment) you need to book your bi annual heart failure review at the above mentioned clinics.

Once you see the nurse for the first time, we will give you an appropriate follow up (either with the doctor or a routine follow up in 6 months). The same day you will then see your personal doctor to overview the checklist and advice on future management.

We think this service will be well-received, and welcome any feedback from your experiences.

Please inform your personal doctor to put on the online system your blood request and urine test and then visit a laboratory of your choice to have your blood test taken.

Further information

https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-management-visual-summary-pdf-6663137725

https://www.heart.org/en/health-topics/heart-failure/heart-failure-tools-resources/heart-failure-guidelines-toolkit

https://www.heart.org/en/health-topics/heart-failure/heart-failure-tools-resources/hf-path-heart-failure-self-management-tool

MENTAL HEALTH ILLNESS

Mental disorders are a leading cause of morbidity worldwide and widespread in industrialised countries. Compared to specialized care, primary care is considered to be more accessible, less stigmatising, and more comprehensive since it manages physical ailments along with mental disorders.

It is evident that in Cyprus patients may feel reluctant to approach a physician to talk about psychological symptoms (i.e anxiety, low mood).Thus we aim to make our patients comfortable to approach their personal doctor or one of the practice nurses, to talk about any anxiety or concern they have. To get a self assessment use the PHQ9 form(for depression) and GAD7 score (for anxiety) found below. There is also a link to online applications for cognitive behavioural therapy (form of counselling) and applications which may help with people having difficulty sleeping (Headspace).

In addition we want to have an annual follow up of all our patients with severe mental health illness (patients with schizophrenia, severe depression, psychosis)  to keep track of their progress.

Novel Practice Severe Mental Illness Service

We are delighted to introduce a new way of delivering our practice mental health service in order to achieve the best possible care for our patients. It is paramount that patients with mental health illness have a regular check-up as mentioned above.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for an bi-annual review going through a checklist with you. Please make sure you have your blood tests, urine test and eye check before coming to see the nurse.

Annual Review Appointments

At the beginning (first ever appointment) you need to book your annual mental health review at the above mentioned clinics.

Once you see the nurse and doctor for the first time, we will give you an appropriate follow up .

We think this service will be well-received, and welcome any feedback from your experiences.

Please inform your personal doctor to put on the online system your blood request and then visit a laboratory of your choice to have your blood test taken.

Further information

DEPRESSION AND ANXIETY

PHQ 9 AND GAD 7 SCORE

https://www.plu.edu/chws/wp-content/uploads/sites/401/2019/05/phq-9-and-gad-7.pdf

COUNSELLING  AND INSOMNIA APPS – HEADSPACE FOR INSOMNIA

https://www.psycom.net/25-best-mental-health-apps

What is dementia?

Dementia is a general term used to describe a set of symptoms. These symptoms often include:

• loss of memory
• mood changes
• problems with communicating
• difficulty completing day-to-day tasks
• problems with reasoning.

Dementia is progressive. This means that the symptoms will gradually get worse. The speed at which this happens usually depends on the person and the type of dementia they have.

There are many different types of dementia and they are often called by the same name as the condition that caused the dementia in the first place.

It is important to support patients with dementia as they will need increasing physical, social and psychological support. It is even more important to support their loved ones whilst they are caring for patients with dementia. Arranging for power of attorney or living wills early on is required.

Novel Practice Dementia Service

We are delighted to introduce a new way of delivering our practice dementia service in order to achieve the best possible care for our patients. It is paramount that patients with dementia have a regular check-up as mentioned above.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for an bi-annual review going through a checklist with you. Please make sure you have your blood tests before coming to see the nurse.

Annual Review Appointments

At the beginning (first ever appointment) you need to book your annual dementia review at the above mentioned clinics.

Once you see the nurse and doctor for the first time, we will give you an appropriate follow up .

We think this service will be well-received, and welcome any feedback from your experiences.

Please inform your personal doctor to put on the online system your blood request and then visit a laboratory of your choice to have your blood test taken.

Further information

Societies and support groups

http://cypatient.org/iθακη-φιλανθρωπικός-σύνδεσμος-στήριξ/

https://cyprusalzheimerassociation.weebly.com/omicron-sigmaupsilonnudeltaepsilonsigmamuomicronsigma-mualphasigma.html

Cancer prevention and early detection is very important as prognosis is directly related to how much the cancer has progressed. Indeed, cancer is the second leading cause of death in Cyprus (following cardiovascular disease) so as a novel primary care centre we want to try and identify patients at an early stage. For guidance on red flag symptoms see the link in further information section below.

However, what is equally important is to support patients and their families who have been diagnosed with cancer, as the psychological impact of cancer on the patient and family is significant. Understanding your disease, treatment and keeping a positive outlook is important to fight the disease. Thus, seeing your personal doctor to support you for any concern, at regular intervals is paramount. It is also important to have a formal review within 6 months of diagnosis and then every 6-12 months.

Novel Practice Severe Mental Illness Service

We are delighted to introduce a new way of delivering our practice cancer review in order to achieve the best possible care for our patients. It is paramount that patients with cancer have a regular check-up as mentioned above.

Given there is no current recall system from GESY we wanted to innovate and create a system whereby we inform you what you need to have done in a year (see table) and then see the nurse for a bi-annual review going through a checklist with you.

Annual Review Appointments

Your very first review appointment needs to be booked directly by you at the aforementioned clinic.

Following review by the nurse and doctor, an appropriate follow up will be offered.

We think this service will be well-received,and welcome any feedback from your experiences.

Please inform your personal doctor to request your blood and urine test online and then visit a laboratory of your choice to have your tests done.

We think this service will be well-received, and welcome any feedback from your experiences.

CANCER

Further information

Symptoms which may suggest you need an urgent investigation to exclude cancer or something urgent (red flags) – please note list not exhaustive and each individual patient situation may be different

https://www.gponline.com/education/medical-red-flags

Societies and support groups

https://www.anticancersociety.org.cy/el/page/home

http://www.bococ.org.cy/el/yperesies-syndesmon-asthenon