Weight Management Programme in Collaboration with Community Pharmacy
Evaluation January 2006
1 Aims and Objectives
1. To promote and deliver a weight management service, for patients with established chronic disease, from community pharmacies.
2. Improve the health of the target population through health promotion from community pharmacy by utilising the skills of the community pharmacist and pharmacy staff
3. Develop closer working between surgeries and pharmacies by sharing the responsibilities of the weight management services
2 Background
Obesity is defined as a Body Mass Index (BMI) of 30kg/m2 or more; overweight is defined as a BMI between 25.0-29.9kg/m2. Obesity substantially increases the risk of morbidity and mortality in a number of other illnesses, notably diabetes, hyperlipidaemia, hypertension and coronary heart disease. It also plays a role in cancer, reproductive health, mental health, musculo-skeletal disorders and psychological morbidity1. More specifically there is a link between abdominal obesity and coronary heart disease, hypercholesterolaemia, hypertension and diabetes. It has been suggested that even modest reductions in weight may be associated with health benefits with reductions in blood pressure, cholesterol and triglycerides achievable with just a 5-10% reduction in body weight. To obtain long-term health benefits the weight loss must be maintained.
General practice has an increasing obligation to address weight management for patients, particularly those who have existing co-morbidities (i.e. diabetes, hypertension, IHD, arthritis etc.). Practices are faced with increasing demands for nurse and GP appointments for Chronic Disease Management and are finding it difficult to review patients who require ongoing support for weight management.
Community Pharmacy can provide an invaluable resource in monitoring and supporting a weight management programme. Many community pharmacies are equipped with weighing scales and could provide an “open access” scenario for patients to be reviewed without the need for an appointment at the general practice. Pharmacists and their staff are available to counsel and support patients through a weight management programme.
Reference
1. NICE. Orlistat for the treatment of obesity in adults. March 2001. Available from www.nice.org.uk (Accessed 1.3.2004)
3 Pilot Scheme
Three surgeries participated in the pilot scheme, St Andrews Group practice, Dr Blow and Dr Koul (Hessle Road).
Three pharmacies were invited to take part, Lloyds Pharmacy, Hessle Road, Lloyds Pharmacy, Anlaby Road and Moss Pharmacy, Hessle Road. Unfortunately Lloyds Pharmacy, Anlaby Road pulled out of the pilot scheme so Whistlers Chemist, Bethune Avenue were included. The pilot scheme was due to run for six months from 1st April 2005 until September 31st 2005. The scheme was extended for a further month to allow an opportunity for Whistlers Chemist to participate, however they received no referrals from the surgeries.
The nursing teams at the surgery and at least two members of staff from each pharmacy attended a training session run by Paula Hunt, Independent Nutritionist and Dietician from West Yorkshire entitled Behaviour modification in weight management: skills for change. The aims of the training were to introduce the concept of using a behavioural approach for weight management in a pharmacy environment and to increase knowledge of the skills and strategies involved.
To evaluate the scheme, the Nurses were asked to record patients BMI, BP, cholesterol and waist circumference before referral to a pharmacy. At the end of the six-month pilot, the nurses were asked to repeat these measurements to demonstrate any improvement in health.
Patients, pharmacy staff and the nurses were asked to complete an evaluation questionnaire.
4 Evaluation
10 patients participated in the scheme over the six-month period. 2 dropped out with no reason given. All ten patients were sent evaluation forms (appendix 1). Only 3 replies were received on the initial posting, so the forms were resent and a total of 6 replies received.
Overall the patients felt that the pilot scheme was well explained to them, and they found it easy to visit their pharmacy for their weight checks and advice. Only one patient reported a difficulty in attending the pharmacy but they admitted they were often away from home.
Patients found the pharmacy staff pleasant and welcoming on their first visit and the majority of patients felt comfortable and found the staff very supportive when attending for weight reviews. Some patients felt they were a nuisance to the pharmacy if they arrived at busy times; some patients suggested having appointment times. Some patients commented that they felt they could be overheard in the pharmacy when receiving advice, though the installation of consultation rooms should address this problem.
There were mixed feelings from the patients regarding any improvement they felt in their health, although they all described a change in their eating habits and some had changed their exercise habits. Overall the patients were happy with the scheme. Comments included: to continue with the scheme, that they felt good about losing weight and they would like to see the same person at the pharmacy each time to allow relationship building.
Questionnaires were received from two pharmacies, (appendix 2). Feedback was positive, and the pilot scheme allowed appropriate use of skill mix. In the pharmacy where the dispenser conducted the consultations it was felt there was adequate time to spend with the patients whereas when the pharmacist was conducting the review, they felt rushed if the patients attended at the busiest times. The pharmacies felt they had inadequate referrals from the surgery and would like to be able to refer patients themselves.
Two nurse evaluation forms were returned, (appendix 3). They felt that the scheme was useful but would like more feedback from the pharmacies about the patients.
5 Results
Number of patients referred into pilot 10 (information and evaluation on 6 scheme patients) Number of female patients 5 Number of male patients 1 Average age of patients referred 55 (range 32-71) Average loss in BMI 2.12 kg/m2 Average loss waist circumference (cm) 15 Average loss in weight (kg) 6.06 Average length of time patients spent 4 months in the pilot scheme Number of reviews conducted at the 43 pharmacy Average time of consultation 7.5 minutes
Number of reviews conducted by 35 dispenser Number of reviews conducted by 7 pharmacist.
Initial and final cholesterol and blood pressure reading were only obtained for three patients. All patients showed a decrease in cholesterol levels, blood pressure remained approximately the same and one patient showed an increase as shown below.
Initial BP mm/Hg Final BP mm/Hg Initial Final Cholesterol Cholesterol 118/80 160/84 7.4mmol/l 7.0mmol/l 130/70 140/70 4.6mmol/l 4.4mmol/l 120/80 110/80 6.5mmol/l 5.0mmol/l
6 Conclusion
The results show that patients can achieve reduction in weight and an improvement in health with support from Community Pharmacy. The pilot only had very small number of patients participating in the scheme so the scheme will be extended to 10 pharmacies across west Hull, who have expressed an interest in this enhanced service, to allow gathering of more results and further evaluation of the scheme.
The Government White Paper “Choosing Health” commits to developing a “care pathway” for obesity. An extension of this pilot scheme will help to address the issue of obesity across West Hull and allow further evaluation of the benefits with a larger number of patients.
There is a £1000 funding remaining from the pilot scheme and a further £5000 has been secured in the Local Delivery Plan. Training to pharmacies will cost £850 for a full training day on motivational behaviour and nutritional information and will be delivered by a registered dietician.
Referral Criteria
Patient must be registered with a GP in West Hull.
Patient BMI must be calculated to be over 27 for inclusion in the scheme
Note: for patients enquiring about the scheme with BMI 25-27 signposting information will be provided.
Patients can self-refer into the service (pharmacy must ensure they are satisfied that patient is registered with a West Hull GP).
Healthcare professionals can direct patients to a participating pharmacy of the patient’s choice.
Patient must consents to participation in the scheme and attendance at community pharmacy.
Exclusion Criteria
Patients currently taking Sibutramine (ReductilTM) or Orlistat (XenicalTM) Patients under 18
7 Pregnant women
Pharmacy criteria
Pharmacies will have to satisfy the following criteria before they can offer this enhanced service: 1) Have weighing scales (with proof of servicing within last 6 months) and access to equipment/materials as specified in the Service Level Agreement (SLA) 2) Have a suitable consultation area 3) Comply with all essential services of the pharmacy contract.
The pharmacy will also have to nominate TWO team members who will be responsible for running the service. The pharmacist does not have to be one of these nominated team members but would have overall responsibility for the service and will be welcome to attend the training session.
The nominated team members MUST attend a training session covering dietary, lifestyle advice and motivational support to patients.
Payments
Pharmacies will be able to claim a fee an annual fee of £50 per patient registered with the weight management service.
Relaunch of Pilot Scheme
The Weight Management Programme will be launched June 2006 and a local PCT Obesity Campaign will be run in shortly before this period to raise patient awareness of the scheme.
8 Appendix 1
Weight Management in collaboration with Community Pharmacy Evaluation Questionnaire A: Patient
Please circle your response where necessary
1. How well do you feel the weight management scheme was explained to you? Excellent Good Adequate Poor
2. Did you find it easy to visit your chosen pharmacy for weight management advice? Yes No If No, why not? ______
3. How would you describe the pharmacy staff on your first visit? Very friendly & welcoming Pleasant Unfriendly Other, please explain: ______
4. How did the pharmacy staff make you feel when attending for a weight review? ______
5. How easy was it for you to visit the pharmacy for review visits? Very easy Adequate Difficult Impossible
9 6. Did you experience any problems with being seen for follow up reviews at your chosen pharmacy? Yes No
7. Did you feel comfortable speaking with pharmacy staff in the area of the pharmacy used? Yes No If No, why not? ______
8. How would you rate the usefulness of any written information provided to you? Excellent Good Adequate Poor
9. How would you describe the difference to your health since joining and participating in the scheme? Much better Slightly better No change Worse
10. Have you changed the way in which you eat? Yes No If yes, please give brief details: ______
11. Have you changed the amount of exercise that you do? Yes No If yes, please give brief details: ______
10 12. Overall, how would you rate the scheme? Excellent Good Average Poor
13. Have you any suggestions of how to improve this service? ______Thank you for your co-operation.
11 Appendix 2
Weight Management in collaboration with Community Pharmacy Evaluation Questionnaire B: Pharmacy Staff
Name of Pharmacy: ______
Please circle your response where necessary
2. Have you enjoyed participating in this pilot scheme? Yes No Could you provide details of how you may have enjoyed or disliked participating in this pilot scheme: ______
2. Has it increased your level of job satisfaction? Yes No
3. Do you feel this scheme has made appropriate use of the skill mix within your pharmacy? Yes No
4. Do you feel the training/resources provided equipped you with the necessary skills to provide the service? Yes No If No – what other requirements would you have? ______
5. Did you have adequate time to spend with each patient referred into this scheme? Yes No
12 If No, please expand; ______
6. How would you rate the amount and quality of the paperwork involved? Too much Just enough Not enough
7. How would you rate the level of communication with the GP surgery regarding patients referred into the weight management pilot service? Excellent Good Adequate Poor
8. Would you be willing to share your experiences with other pharmacy staff regarding the weight management service? Yes No
9. Would you like to continue providing this service? Yes No If No, why not? ______
10. Do you have any suggestions for how this service could be improved or developed?
13 Appendix 3
Weight Management in collaboration with Community Pharmacy Evaluation Questionnaire C: Practice nurses / GP Please circle your response where necessary
3. How useful did you find this pilot service? Excellent Good Adequate Poor Could you indicate how you found the service useful; e.g. free service available to refer patients to, number of patients enrolled, number of patients successful in losing weight etc. ______
2. How easy was it to identify patients suitable for referral into the scheme?
Very easy Easy Difficult Impossible
3. On average, how receptive were patients to your suggestion to participate in the service? Enthusiastic Willing Uncertain Not prepared to consider
4. How do you rate the level of communication between the practice and the pharmacy that occurred regarding patients referred into the service? Excellent Good Adequate Poor
5. Do you feel patients received an adequate level of support via this service? Yes No If No, why?: ______
6. Would you like the service to continue?
14 Yes No If No, why?: ______
7. Do you have any suggestions for how the service could be improved or developed?
15