Presentation on theme: "Community Pharmacy as a setting for weight management service pilot Herefordshire PCT."— Presentation transcript:
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 1Assessment by Pharmacist50 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 options10 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
Table summarising results Completers to Weeks 1- 8 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 patients56 patients40 patients29 patients 97 patients Average weight on recruitment (kg)92.7kg89.3kg88.4kg88.3kg90.8kg Average weight on last reading (kg)91.4kg86.2kg83.5kg81.8kg87.8kg Average weight loss (kg)1.3kg3.1kg4.9kg6.5kg 3kg Average % weight loss per group of patients1.4%3.5%5.5%7.4%3.3% Average BMI on recruitment 35.333.6 32.734.3 Average BMI end of programme33.131.831.530.232.3 Average waist measurement on recruitment106.5cm104cm104.1cm102.2cm 104.9c m Average waist measurement reduction at end of programme 2.3cm7.9cm8.2cm9cm7.9cm Percentage population achieved 5-10% weight loss 5%48%55%100%30%
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 we- weighing. 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 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 http://www.pcc.nhs.uk/uploads/medical/april_07/ obesity_framework_march_07.doc
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