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CVD risk management system: screenshot of first question in Encounter 1
Confidential – not to be copied or circulated without permission from Prof C Salisbury
CVD risk management system: screenshot of example question during Encounter 2
Confidential – not to be copied or circulated without permission from Prof C Salisbury
CVD risk management system: Screenshot example of smoking cessation advice during Encounter 2
Confidential – not to be copied or circulated without permission from Prof C Salisbury
CVD risk management system: Screenshot example of smoking cessation information to send to patient during Encounter 2
Confidential – not to be copied or circulated without permission from Prof C Salisbury
Excerpts of computerised scripts from the Healthlines Service for CVD risk
NB: This content has been reproduced with permission from Solent NHS Trust.
Extract from HIA script for CVD risk - Statin Module 56
NB: This module discusses the risks and benefits of taking statins and explores a
patient’s suitability for taking it.
56.0Script HIA: Have you already delivered the Statin module during this call?
o 1= Yes I have - go to next module 1(4.0Script), 2(6.0), 3(8.0), 4(4.0Script),
5(19.0Script), 6(21.0b/21.0/21.0a*), 7(8.0), 8(21.0b/21.0/21.0a*), 9(8.0), 10(20.0),
11(14.0), 12(21.0b/21.0bScript/21.0a_6*)
o 2= No I have not - continue to Statins (go to 56.0)
[56.0Script]
56.0
Are you currently taking a statin?
If No – Stopped taking on own:Ask subject WHY and WHEN. This can be added to the
NOTES section of computer program.
If No – My doctor ordered it to be stopped or No – it was never prescribed:
Remove stopped medicine(s) from the medication list.
o 1 = Yes (go to next module 1(4.0Script), 2(6.0), 3(8.0), 4(4.0Script), 5(19.0Script),
6(21.0b/21.0/21.0a*), 7(8.0), 8(21.0b/21.0/21.0a*), 9(8.0), 10(20.0), 11(14.0),
12(21.0b/21.0bScript/21.0a_6*)
o 2 = No – stopped taking on own
(go to 56.0a)
o 3 = No – my doctor ordered it to be stopped (go to next module) 1(4.0Script),
2(6.0), 3(8.0), 4(4.0Script), 5(19.0Script), 6(21.0b/21.0/21.0a*), 7(8.0),
8(21.0b/21.0/21.0a*), 9(8.0), 10(20.0), 11(14.0), 12(21.0b/21.0bScript/21.0a_6*)
o 4 = No – it was never prescribed (go to 56.1)
56.0a Is your doctor aware that you have changed/stopped this medicine(s)?
o
o
o
o
1 = Yes
(go to 56.1)
0 = No
(go to 56.0b)
777 = DK
(go to 56.0b)
888 = Refused
(go to 56.0b)
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[statin0a]
56.0b It is important to tell your doctor if you are having trouble with your cholesterol
medicine. Its best to discuss any changes with him/her before changing or stopping
your medicine(s). You and your doctor should work together to find the right
cholesterol medicine(s) for you. I encourage you to contact your doctor within this
week to inform him/her about your decision.
o Go to next module (go to1(4.0Script), 2(6.0), 3(8.0), 4(4.0Script), 5(19.0Script),
6(21.0b/21.0/21.0a*), 7(8.0), 8(21.0b/21.0/21.0a*), 9(8.0), 10(20.0), 11(14.0),
12(21.0b/21.0bScript/21.0a_6*)
56.1 I will now discuss the risks and benefits of taking a statin. If you decide that you
want to start taking a statin we will complete a brief assessment and send this to
your GP so you can discuss this further.
Note to HIA: Use critical thinking to go through the risk and benefits of statins. Not all
statements need be used depending on the patient’s reasons for not taking a statin.
Benefits of statins
1. Lowers your risk of having a heart attack or stroke.
If you have certain risk factors including raised blood pressure, being a smoker and
being overweight then you have a 2 in 10 chance or more of developing
cardiovascular disease in the next 10 years. Taking a statin can substantially reduce
this risk.
2. Reduces the amount of cholesterol made by your liver.
Excess cholesterol is deposited in the blood vessels (atherosclerosis).This narrows the
blood vessels and limits the amount of blood and oxygen delivered to your body. If
this happens to the blood vessels (coronary arteries) in the heart muscle, it can cause
chest pain (angina) and in severe cases, a heart attack (myocardial infarction). If this
happens to the blood vessels in your brain, it can cause a stroke.
Confidential – not to be copied or circulated without permission from Prof C Salisbury
Risks of statins
1. Most people do not get side effects or just minor ones that getter better with time.
About 1-3% of people get minor side effects. These include tiredness, vague aches
and pains, headache, feeling sick, indigestion, diarrhoea or constipation.
2. Important but rare side effects are muscle problems and liver problems.
Muscle problems (myopathy) - Muscle and tendon pain, stiffness, muscle weakness or
cramping. You should tell your doctor if you get any of these. Stopping the statin or
reducing the dose will usually return your muscles to normal.
Liver problems – If you take a statin, you will have regular blood tests to check on
your liver. People with liver disease or persistently abnormal liver tests should not
take a statin unless considered necessary by their doctor. If you get liver
problems,stopping the statin or reducing the dose will usually return your liver to
normal.
3. Statins have interactions with a number of other medicines.
You will need to discuss this with your doctor. Always check the patient information
leaflet that comes with your medicine before taking it.
If you would like more information I can email you a leaflet:
http://www.patient.co.uk/health/Statins-%28Cholesterol-Lowering-Medicines%29.htm
o 1= Information provided (go to 56.2)
o 0= Information not provided (go to 56.2)
[statin1]
56.2
Does the patient want to be referred to their GP to discuss taking a statin?
o 1= Yes – complete patient assessment / GP referral letter (go to 56.3a)
o 0=No – go to next module (go to 56.2script)
[statin2]
56.2Script HIA: Which module do you need to go to now?
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If you need to complete the Medicines module choose the first option, otherwise
choose ‘Go to next module’ option.
For a subject initiated call, ALWAYS choose the first option to return to Medicines
module.
o 1= Go back to Medicines module (go to 2.4e1)
o 0= Go to next module1(4.0Script), 2(6.0), 3(8.0), 4(4.0Script), 5(19.0Script),
6(21.0b/21.0/21.0a*), 7(8.0), 8(21.0b/21.0/21.0a*), 9(8.0), 10(20.0), 11(14.0),
12(21.0b/21.0bScript/21.0a_6*)
*(Programming information: The system will automatically go to one of three options for
encounters 6, 8 and 12, depending on the conditions set as follows21.0b – If the patient’s BMI <25
21.0 – For encounter 6 and 8 - If the patient’s BMI is 25 or more and they set a weight loss
goal in encounter 3
21.0bScript – For encounter 12 - If the patient’s BMI is 25 or more and they set a weight
loss goal in encounter 9
21.0a – For encounters 6 and 8 - If the patient’s BMI is 25 or more and they did not set a
weight loss goal in encounter 3
21.0a_6 – For encounter 12 – If the patient’s BMI is 25 or more and they did not set a
weight loss goal in encounter 9
[56.2Script]