South West Regional Action Day

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(No Transcript)
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South East Coast Pharmacy White Paper
The vision for Community pharmacy in the future
NHS the Provider Experience of Vascular
Checks Deirdre Doogan, Director of Government
Relations and Pharmacy Services
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Lloydspharmacy - credentials

• The business
• Over 1,700 pharmacies in the UK, all in local
  communities
• Over 2 million people visit a Lloydspharmacy
  every week
• First community pharmacy chain to introduce
  private consultation rooms - now in over 1500 of
  our pharmacies
• First pharmacy chain to be EPS accredited
  (Electronic Prescription Service).
• 300 pharmacies integrated into health centres
  with GPs and other healthcare professionals.
• Market leader on provision of Medicines Use
  Reviews, of which we have conducted over 500,000
  to date
• Health Inequalities
• Lloydspharmacy has 450 pharmacies located within
  62 spearhead PCT areas providing accessible
  healthcare
• 603 pharmacies in under doctored areas
• Extended pharmacy opening hours and out of hours
  services
• Driving public health
• Over 1 million free diabetes checks nationwide
• Over 1.5 million free blood pressure tests
  nationwide
• Delivering the Heart MOT with Birmingham PCTs,
  this targets the most vulnerable population
• Medication Use Reviews- 500,000 carried out to
  date
• Delivering vascular checks following the
  successful delivery of the Heart MOT with
  Birmingham PCT. Ready to deliver National
  Vascular Screening Programme as announced by
  Gordon Brown in January.

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The evolving role of community pharmacy in CVD
care
Prevention
Prediction
Personalised Continuity of Care

• Information choice
• Behavioural change
• Diet exercise
• Weight management
• Smoking cessation
• Alcohol awareness

• Vascular risk checks
• Type 2 diabetes checks
• Blood glucose
• Cholesterol TC, HDL
• BP
• BMI waist circumference

• First script compliance
• Repeat Rx
• Medicines use review
• Medication review
• Long Term Condition monitoring

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Overview

• Case study 1 - Pharmacy based opportunistic
  checks
• Objectives
• Service development
• Patient engagement
• Results
• Case study 2 - Pharmacy delivered targeted
  systematic programme
• Overview of the service
• Outcomes

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Why offer a Heart MOT Service?

• Cardiovascular disease (CVD) is the biggest
  killer in the UK

Deaths in the UK are amongst the highest in the
world with 198,000 deaths each year1 More than 1
in 3 people (35) die from CVD1 Multiple risk
factors associated with CVD (e.g. high
cholesterol) CVD is estimated to cost the UK
economy around 30.7 billion a year (NHS costs
14.4 billion)2
1CHD statistics (2008) www.heartstats.org 2British
Heart Foundation, Coronary Heart Disease
Statistic, 2008 Edition
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Cardiovascular disease

• Birmingham
• MLE (74 years old) wide variation across
  different areas within the city

Prevalence of CHD in Birmingham (QOF)
Standardised Mortality Rates for CHD in Birmingham
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Partnerships
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Service development
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Cardiovascular risk calculated to ensure GP
acceptance of referrals
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Service in line with Joint British Societies
guidelines (JBS2)
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CVD risk calculated using clinically accepted
Framingham equation
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Service designed in conjunction with H.E.A.R.T.
UK
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Total and HDL cholesterol measured using MHRA
approved Cholestech LDX
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SOPs used to ensure high standards are achieved
and maintained
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Training requirements

• An overview of CVD and its risk factors
• Prevention, including healthy lifestyle
  information
• Treatment pathways
• Practical session on testing procedure
• Practical session on the use of the IT system to
  calculate CVD risk
• Consultation skills
• Case studies
• Assessment

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Patient journey
Recruitment and consent
CVD risk assessment TC, HDL, BP, blood glucose,
BMI, waist circumference, family medical
history and lifestyle assessment
Immediate results CVD risk calculated
Patient receives advice from trained pharmacist.
If appropriate, patient is referred to GP, or if
at low risk to a health trainer
Patient receives printed copy of results and
lifestyle advice
Copy of results given to GP practice
Follow up
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Materials
Information booklet Contains healthy lifestyle
information
Service leaflet Assesses if the service is
appropriate
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Creating a position for the service Heart MOT
Heart MOT accessible and vocabulary familiar to
all men in the target age group. Succinctly
captures the essential elements of the service
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Engaging with Men Aged 40
Reaching the heart of the community targeted
door drop activity to engage men by adapting
familiar objects, language and creating a
compelling incentive to have a Heart MOT
Get your heart racingand checked out Targeted
door-drop offering a Ferrari driving experience
as a competition prize to act as an incentive to
have a test
Valentines MOT Certificate Targeted door drop,
primary target was women as the gatekeepers of
family health
competition prize donated by supplier
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Creating visibility in the wider community
Maintaining visibility mechanics targeting local
businesses, within participating pharmacies and
mobile ad-vans all helped to reinforce the
door-drop messages
Ad-Van example side panel
Local Businesses and Pharmacy POS
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Service outcomes
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Nearly 900 patients checked by Lloydspharmacy
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49 referred to GP
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27 referred due to high CVD risk - 82 Male 18
Female
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High level of uptake in deprived areas with poor
MLE
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Early referral follow up shows treatments
started
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Benefits

• To the patient
• Increased awareness of risk factors for CVD
  within the local population
• Good access to the service through community
  pharmacy
• Increased choice in areas in which health
  inequalities have been identified
• Helps individuals to make positive lifestyle
  adjustments to prevent disease
• Ensures those with a high risk are referred to
  help reduce the onset of complications

• To the Primary Care Trust or commissioning body
• Facilitates early detection of high risk patients
• Helps to reduce health inequalities within
  socially deprived areas
• Good access through the community pharmacy will
  help to reach those who may not contact their GP
  practice
• Early identification should help to reduce long
  term cost implications to the NHS

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Case finding men at risk- Pharmacy delivering
targeted systematic checks in the community

• BHWP commissioned Enhanced Healthcare Services to
  work with GP practices to extract patient records
  on men over 40 years
• Following a tender process BHWP commissioned
  Lloydspharmacy to provide clinics at evening and
  weekend
• NHS and non-NHS settings e.g. health centres,
  football clubs churches
• Patients are invited to attend for a full check
• Total cholesterol HDL
• Blood sugar
• Blood pressure
• BMI
• Patients are referred to the GP practices, or if
  appropriate, a Health Trainer or PCT established
  services e.g. Stop Smoking
• Results are sent to the GP practice

Aston Villa and Birmingham City Football Grounds
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Case finding men at risk - results

• On average 70 to 80 attendance rate if
  appointment confirmed by phone
• Over 9,500 males over the age of 40 have been
  checked
• 65 of patients were referred
• 30 identified with elevated BP
• 35 identified with elevated cholesterol
• 18 identified with elevated blood glucose
• 36 identified as having a high CVD risk
• 99 satisfied with appointments, with the tests
  and the explanations given
• 98 would recommend the service to a friend
• 75 had a wait of less than 30 minutes
• 76 plan to make changes as a result of the
  clinic

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Heart MOT demonstrating the key role community
pharmacy can play within public health