| When Steve Simmonds, director of pharmacy development at Howard & Palmer
pharmacy in Swansea, wrote a practice proposal for his Welsh Centre for
Post-graduate Pharmaceutical Education medicines management certificate,
it was meant to be theoretical. However, his proposal, to help patients
lose weight, was identified as having significant potential and it was
decided that it should be tried as a pilot.
Six months later, the weight reduction support clinic pilot is nearing
completion in the Howard & Palmer pharmacy in Morriston, in conjunction
with the local GP surgery. It is showing positive results.
Dewi Cook: “It’s all about support, motivation and education” |
Dewi Cook, pharmacy manager who runs the clinic, is a firm believer
in the positive impact of pharmacist involvement in extra services and
was
happy for the chance to run this clinic. “The clinic focuses on
patients in danger of developing secondary symptoms of obesity, or who
are trying to change their lifestyle but need support to do this,” he
told The Journal. “It’s all about support, monitoring and
education.”
After liaising with GPs from the local surgery, Strawberry Place, referral
parameters were agreed by which patients could be referred to the clinic.
Mr Cook also displays a poster in his pharmacy window, inviting patients
to walk in and discuss how the clinic could help them. The clinic is
being run as a six-month programme, and takes place in the consultation
area of the pharmacy every Wednesday.
“Patients are drawn by the convenience of the local pharmacy,” says
Mr Cook. “More people are starting to appreciate the constraints
that GPs have on their time, and may feel that they are not ‘ill’ enough
to see their doctor”. However, Mr Cook believes that if rolled
out on a larger scale, the programme has the potential to result in significant
future cost savings in primary and secondary care.
Outline details of the weight reduction support clinic
During the six-month programme, patients come
into the clinic once a month. Mr Cook uses a weight management
record card to record
the patients’ weight, blood pressure, body mass index, waist
circumference, blood glucose levels and cholesterol levels. He
then sets them dietary goals, activity goals and weight loss goals
to reach by the next session.
“Many patients have been living this way for 30 or 40 years, so these
are major changes for them,” explains Mr Cook. “I try
to add in a small, manageable change each month. For example, in
the first session I would encourage them to eat less fat, in the
second session I would discuss reducing their portion size, and in
the third session I would introduce the idea of exercise. Some of
my patients are well into their 60s and may have arthritic disease,
so an activity such as cycling would clearly be unrealistic. For
these patients I encourage chair exercises and flexibility exercises.”
In one session, Mr Cook asks patients to bring in some food labels.
He teaches them the meaning of nutrition information and how to read
the labels to assess fat content, calorific values and salt levels.
Patients also have the opportunity to visit their local supermarket
together with an obesity management adviser to put Mr Cook’s
advice into practice, and to gain a better understanding of the types
of foods they should be looking out for. “There is general
belief that healthy eating is expensive,” says Mr Cook. “I
aim to show patients that a healthy lifestyle does not have to be
expensive but can be accessible to everyone. For example, patients
do not have to buy products that are marketed as being low fat and
may be more expensive, but they just need to understand what to look
for on a food label.” He explains that some supermarkets sell
value meals for under £1 that are low in sugar, salt and fat. |
According to Mr Cook, motivation is an important factor for success.
Before enrolling patients, he uses a motivational questionnaire to assess
whether the patient is ready to lose weight. “I have patients on
antipsychotics, steroids and thyroid medication who have to work harder
for a smaller benefit,” he explains. “In these patients,
success lies in motivating them to realise that even a weight loss of
one pound a month will benefit their health.”
Mr Cook enters the patient data onto a computer system and feeds the
figures back to the surgery. If, in his opinion, a patient would benefit
from pharmacological intervention, Mr Cook specifies this on a referral
form that he sends to the GP.
There are currently 23 customers going through the weight reduction programme.
About 15 of these were referred to the clinic by the GP surgery, and
the remainder walked into the pharmacy in response to the poster in the
window. “I have had some patients drop out which can be demoralising
after spending that much time with them,” Mr Cook admits, “but
it is rewarding to see the success as well.”
Patients come back for a patient service audit six months after they
have finished the programme. “This allows me to assess how well
they have coped alone, or if constant support is needed,” he says.
He adds that although the pilot consists of just a six-month programme,
patients are welcome to come back to see him. “A key point is my
availability,” he says. “Patients know that I am always here,
and even after the six months they can pop in to use the scales and have
a five-minute chat.”
Of the eight patients who have completed the six-month programme so far,
four have lost a stone in weight, one has lost half a stone and four
either did not lose weight or they returned to their original weight
after the programme.
An independent audit will be performed in May, after which Mr Cook plans
to approach Swansea Local Health Board to try to secure funding for the
scheme. All local health boards in Wales have been charged with having
an action plan in place for the “opportunistic screening and support
of those at risk of developing CHD”. Mr Cook hopes that this proposal
will support the LHB in meeting its national service framework and health
improvement modernisation programme objectives.
Mr Cook says that as well as seeing the pilot scheme rolled out on a
large scale, he would like to have continued monitoring of patients after
they have been prescribed weight loss drugs. He hopes that in the future
the provision of weight loss drugs via patient group direction will be
possible. |
The
Pharmaceutical Journal