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| Case Studies |
Leicester PCT
The Leicester PCT project has been a complete success and is the model being adopted by many other PCTs across Britain. The project has been written up and is now considered to be the gold standard by the UK National Screening Committee (NSC) and published as ‘The Handbook for Vascular Risk Assessment, Risk Reduction and Risk Management’ in March 2008. Further copies of this book can be obtained from www.screening.nhs.uk/vascular.
The population of Leicester is 300,000 of which 17,000 are Diabetic. 40% are of ethnic origin, 25% are Obese, 25% are Smokers and 17% Abuse Alcohol.
Death rates from all forms of illness are 20% higher than would be expected and Leicester is 20th most deprived area in Britain. The Leicester PCT introduced a Cardiovascular Health Check Scheme. The CardioChek PA was used to provide the lipid profile for all patients involved in the scheme.
The scheme involved Pharmacists and other Healthcare professionals targeting groups most at risk including middle aged men from ethnic group. The protocol involved an I.T. Health Screen Questionnaire relating to Weight, Height, Medication, and Smoking etc.
The test were performed by the Professional who then lifestyle advice and possible referral to GP.
Captured results were sent to PCT for collation.
North Tyneside PCT
The government identified men over 50 in deprived areas as a priority for health improvement initiatives. North Tyneside PCT decided to set up a project based on high street pharmacies to screen such men for CHD. The PCT pharmacy team took the lead developing the programme, recruiting pharmacists and arranging training. Clinical Chemistry at North Tyneside General Hospital (NTGH) was asked for assistance in selecting and using the point of care testing devices for blood glucose, total and HDL cholesterol. Others in the team were a secondary-care dietician, consultant community cardiologist, vascular disease nurse specialist and a GP.
The CardioChek was selected for lipid tests. Training in use of the meters was given by company representatives to the participants. 18 high street pharmacies joined the project, and sessions were also held in venues such as community halls and working men’s clubs.
This project is continuously being refined and is still ongoing.
Islington PCT
On 11th August 2008, 11 pharmacies in the most deprived areas of Islington, London were commissioned by the Islington Primary Care Trust for a 6-month pilot assessing cardiovascular risk using Cardiochek for lipid tests.
"Islington is the first borough in the country to implement this pilot pharmacy-based screening project, leading the way in taking steps to widen access to health advice and to combat the prevalence of CVD in the borough."Rachel Tyndall, Islington PCT’s Chief Executive (12th August 2008).
Mid Essex PCT
Lyn Mowforth (Health Promotion Advisor, Mid Essex PCT) regularly organises public health awareness events with over 3,000 attendees, many of which wish to have their cholesterol checked. As many as 140 members of the public are tested in a single day at an event. Lyn said her CardioChek PAs were fantastic for promoting health to the general population.
Lyn was able to identify those with raised risk factors and advise them on healthy lifestyle choices, while referring the most at risk to their GPs. Portability, ease of use and reliability are the main factors to consider when choosing a lipid analyser for projects such as this.
Surrey PCT
Liz Patroe (Service Improvement Manager for Surrey Heart and Stroke Network) uses the CardioChek PA for primary care based health checks. The Surrey Heart and Stroke Network aims to identify the patients most at risk of a future, significant cardiovascular event using the Qrisk2 algorithm. CardioChek PA is the analyser of choice to provide all the lipid profiling for the patients. The work being carried out in Surrey has revealed some surprising results, especially regarding health discrepancies between male and female patients.
Asda
Asda have taken the decision to improve their testing service by including total cholesterol and HDL cholesterol testing into their current scheme of blood glucose, pressure and BMI. Thus, they will commence a programme on 2nd January 2010, offering a cardiovascular programme in line with the Department of Health’s requirements into 2010.
For the first two months Asda will offer a free testing service to the public in pharmacy which will include blood pressure, blood glucose, a BMI estimation and cholesterol tests. After the initial period; Asda plan on charging a nominal fee to cover the cost of the operator and testing equipment. Asda have funded the project internally as part of the business development of pharmacy.
Each store is being trained at present with a high level of motivation and enthusiasm to start in the New Year.
Coventry PCT
In Coventry over half the adult population is overweight and 23% are clinically obese. Of the children aged 5-15 yrs living in Coventry, 28% of girls and 22% of boys are overweight. 18.5% are obese. 60% of the population eat less than 5 portions of fresh fruit and vegetables per day. Only 22% of the population travel to work on foot, bicycle or public transport.
In January 2007, a new pilot study was launched by Coventry Teaching Primary Care Trust using the skills of pharmacists to offer lifestyle advice for people to manage their weight over the long term. The scheme, “Management of obesity with associated risk factors”, provides an individualised, pharmacist-led service for patients with a body mass index of 30 to 35, with at least one diagnosed or established risk factor, such as hypertension, type 2 diabetes, raised total cholesterol or waist circumference greater than 102cm for men and 88cm for women. During the pilot, 10 pharmacies in Coventry provided the weight management service, with a target of helping 15 patients per pharmacy during the 12 months. The weight management service was set up collaboratively with a number of stakeholders including the Department of Health, five pharmaceutical companies (including BHR), Unichem Professional Services and leading obesity experts including Dr Terry Maguire.
After 6 months, around 140 overweight individuals have been recruited to the scheme and some 400 follow-up appointments had taken place.
Thirty of the patients who completed the first year of the Coventry Community Pharmacy Weight Management Project shed a combined total of around 20 stones (127.3kg), supported by regular visits to their local chemists to be weight and get helpful tips. Many of them also lowered their blood pressure and cholesterol levels as a result.
Ashwin Hindocha, owner of Mount Nod Pharmacy in Coventry, shares his enthusiasm for the 12-month scheme. He points out that the response from patients has been excellent:
"We have been fortunate in the sense that they do want to lose weight — they started with a positive outlook."
Mr Hindocha stresses that the scheme is about health management, not just about obesity and losing weight, and underlines the importance of conveying this thoroughly to the participants. The patients and pharmacists look at other risk factors such as diabetes, cholesterol, blood pressure or any related medication that the patient is on. For example, "They look at their cholesterol and they want to do something about it."
Sainsburys
The Sainsburys Cardiovascular health checks programme started in April 2009 with a plan to test 75,000 people across the UK, offer lifestyle advice and increase sales of Flora ProActive. The campaign ran till August 2009 when the 75,000 tests were completed. The tests were offered to all the public. This proactive screening programme was funded by Unilever to increase awareness of the risks of high cholesterol and the value of using cholesterol lowering foods. A free cholesterol test throughout the 189 Sainsbury’s stores where there was a pharmacy present together with discount vouchers for product and posters to market the campaign.
Sainsbury’s used the triple test strip providing total cholesterol, HDL-cholesterol and blood glucose to provide a substantial cardiovascular screen. The benefit of the triple test strip with CardioChek was the immediate result, the impact to the customer and it met N.I.C.E guidelines on cholesterol testing which is a minimum of total cholesterol and HDL-cholesterol. The traffic light system was used, and customers found to have cholesterol between 5.0mmol/L and 6.5 mmol/L and a HDL of less than 1mmol/L were given dietary and lifestyle advice whilst those with a cholesterol level greater than 6.5mmol/L were referred to their General Practitioner immediately.
Feedback from the pharmacy team at Sainsbury’s is that this campaign has been the single most successful in their history and has brought pharmacy much closer to the core business through the provision of testing and advisory services adding clear value to both Sainsbury’s and the customer alike.
75,000 people across the UK have been screened for CVD risk, and where necessary signposted to the GP for follow up. The service has been very positively received by pharmacy and customer, and in the eyes of Sainsbury’s corporation, has provided a very valuable ethical service to the customer: to guide people into living healthier lives through proper lifestyle advice both through better eating habits and also increased physical activity levels. |
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