Transcript Community Pharmacy as a venue for weight management service

Community Pharmacy as a
setting for weight management
service pilot
Herefordshire PCT
Why weight management?
 Herefordshire has an adult obesity rate
significantly above the English average at 26.4%
 The estimated cost of diseases related to
obesity in Herefordshire was £24m in 2007 and
is predicted to rise to £29.9m by 2015
 Personalised support for overweight and obese
individuals is one of the key 5 themes in the
government’s “Healthy Weight, Healthy Lives”
strategy and we need an “increasing national
understanding of what works”
Why community pharmacy as a setting?
“More support needs to be provided to those who
wish to move towards a healthier weight”, and
Healthy Weight, Healthy Lives, 2008
“Pharmacists are one of the key professional
groups identified by NICE as in a good position to
help patients make healthy lifestyle choices due to
their credibility and accessibility within the
Community”
NICE obesity, 2006
Key partners
PCT Public Health
Associate Director
Health Improvement Manager (Obesity)
Public Health Secretary
PCT Primary Care
PEC Governance Pharmacist
Acute Trust Dietetic Department
Dietitian (Obesity)
Local Pharmaceutical Committee
Funding
Jointly between Primary Care and Public
Health
Pilot scheme for 104 patients
Rate negotiated with LPC
Cost approximately £7850, excluding
officer time and weighing scales
Programme objectives
 To pilot and evaluate the process of running a weight
management service in the pharmacy setting
 To offer a unique support programme to help patients
understand weight management.
 To tailor timing and level of discussion according to
individual patient needs.
 To combine advice on diet and physical activity with a
behavioural change approach to encourage long term
lifestyle change.
 To reduce patients’ weight by 5% at 3 months with a view
to maintaining this weight loss at 6-12 months.
Programme design
Week 1
Assessment by Pharmacist 50 mins
Weeks2-10
20 mins
Topics, such as food diary;
achieving 10% weight loss;
goal setting; reading food labels;
increasing physical activity;
use of pedometer with Assistant
Week 12 Support options
10 mins
Training
Two evening meetings for pharmacist and at
least one pharmacy assistant from 5 pilot
site pharmacies
1. assessment; raising the issue; goal
setting; dietary advice; behaviour change
2. weight maintenance; physical activity;
food labelling; comfort eating; follow-on
support
Educational Resources
 Your weight, your health series
 Eatwell
 BMI wheels and waist circumference measures
 Food labelling guide
 Fact sheets on emotional eating; eating out
 Physical activity leaflets
 Food and activity diaries
On recruitment
Ages 18-80; higher than expected rate
from 41-60 year old group
Gender – 87% Female
Socio economic status – higher than
expected from semi-routine occupations
Weight – 90.8kg; range 64-134kg
BMI – 34.3
Waist circumference – all at increased risk
Completers
to Weeks 18 only
“early
finishers”
Completer
s to Weeks
9-12
“pretty
much
made it”
Completer
s to week
12
“hung on
in there”
Those
who lost
>5%
“goal
hitters”
Overall
populat
ion
(n=97)
41 patients
56 patients
40 patients
29 patients
97
patients
Average weight on recruitment (kg)
92.7kg
89.3kg
88.4kg
88.3kg
90.8kg
Average weight on last reading (kg)
91.4kg
86.2kg
83.5kg
81.8kg
87.8kg
Average weight loss (kg)
1.3kg
3.1kg
4.9kg
6.5kg
3kg
Average % weight loss per group of patients
1.4%
3.5%
5.5%
7.4%
3.3%
Average BMI on recruitment
35.3
33.6
33.6
32.7
34.3
Average BMI end of programme
33.1
31.8
31.5
30.2
32.3
106.5cm
104cm
104.1cm
102.2cm
104.9c
m
2.3cm
7.9cm
8.2cm
9cm
7.9cm
5%
48%
55%
100%
30%
Table summarising results
Average waist measurement on recruitment
Average waist measurement reduction at end
of programme
Percentage population achieved 5-10%
weight loss
Outcomes
 At 3 months - statistical analysis - Paired t test
result and the Wilcoxon signed-rank test
provided values of less than p<0.0001 at the
95% confidence interval
 At 6 months, 23 (24%) presented for weweighing. 19 had maintained >5% weight loss; 5
had put on weight since last recorded weight;
none regained weight over their original weight;
and further mean waist reduction of 3cm
Learning
 What went better than expected:
 recruitment of sites and patients
 weight loss
 waist measurement reduction
 What went less well:
 Retention (appears comparable)
 Follow-up measurements
 Next time tips:





Joint working
key stakeholders
evidence base
visit the pharmacies for quality control
ensure higher profile to importance of follow-up measurement
Further thoughts
 The Pharmacy White Paper Pharmacy in
England: Building on strengths- delivering the
future-proposals for legislative change and the
proposals. April 2008
 Vascular Checks described in Primary Care
Service Framework. Primary Care Contracting
available at: http://www.pcc.nhs.uk/news/531
 Primary Care Service Framework:
Management of Obesity in Primary Care
available at:
http://www.pcc.nhs.uk/uploads/medical/april_07/
obesity_framework_march_07.doc