Jon David: empower patients with the knowledge to change their lifestyle |
Jon David, proprietor of Neyland Pharmacy in Pembrokeshire, has always
been interested in sports and fitness. It was during training for representing
Great Britain in the annual “Ironman” triathlon, which consists
of a 2.5 mile swim, 112 mile bike ride and a 26 mile run, that he had
the idea
of introducing “exercise prescriptions” to his pharmacy.
During sports performance testing at a leisure centre, Mr David was given
a prescription for his own training, with details such as what speed
to run on the treadmill and at what rate to cycle. “I wondered
why there shouldn’t just be a basic lifestyle prescription for
some of my customers who may be at risk of developing coronary heart
disease” he told The Journal. “Such a prescription would
incorporate smoking cessation, dietary advice, a look at how much alcohol
was being consumed and advice about which type of exercise to do.”
Lifestyle clinics
A few months later Mr David was running a pilot “healthy lifestyle” clinic
in his pharmacy aimed at customers who would not normally visit their
GP, yet might be at risk of developing coronary heart disease in the
future. Mr David ran the pilot for a year, performing health checks on
40 people who were referred to his clinic from the local GP surgery,
or were recruited by a poster advertising the service in the window of
the shop.
The lifestyle check included blood lipid and glucose profiles, blood
pressure testing, height and weight, smoking, diet, alcohol consumption
and level of physical activity. Mr David used a computer programme that
has been validated to calculate the customer’s relative risk of
heart attack, to illustrate visually how small lifestyle changes could
reduce the patient’s risk, and to help patients see where positive
changes could be made. He advised customers on how physical activity
could be incorporated into their daily lives. Patients had follow-up
assessments three months and six months after the initial consultation.
On average, significant health benefits with regard to cholesterol levels
and weight loss were achieved for patients within three months.
“It’s really about empowering people with a little bit of knowledge
so they can improve their lifestyle,” he explained, “For
example, with small changes in exercise and diet, and a reduction in
smoking, the overall effects are huge. If a customer had a lift from
their house every day, I would suggest they got picked up a 10-minute
walk down the road, and ate an apple on the way. Just a few little changes
and a bit of advice and encouragement made real differences to a lot
of people.”
Mr David’s pilot showed that this model of lifestyle could be adopted
in any community pharmacy. Project expansion
Publication of his results, with the help of Sarah Hiom, All Wales
specialist pharmacist for research and development, provided a platform
for the
Pembrokeshire Pharmacy Forum to apply to the local health board for
funding as part of an “inequalities in health” project
to target coronary heart disease. Funding has now been secured and
lifestyle clinics similar to the one piloted by Mr David are expected
to be rolled out in eight community pharmacies in Pembrokeshire over
the next few months.
Pharmacists will get paid up to £600 per year for running the clinics
and meeting screening targets. Chris Martin, chairman of Pembrokeshire
LHB told The Journal: “By receiving funding as part of this project
community pharmacy has been recognised as being a full member of the
primary health care team and having a huge contribution to make to public
health as a whole.”
Mr David’s next project was to design a series of lifestyle clinics
in Camarthenshire, together with John Llewelyn, proprietor of Brynamman
pharmacy, that would run in conjunction with social and leisure service
departments at the local council. The scheme, which is still in a planning
stage and expected to start this autumn, will involve local community
pharmacies carrying out a coronary heart disease risk factor assessment
and then, with the patient’s consent, supplying these details to
trained staff at the local leisure centre. The leisure centre staff will
then create an “exercise prescription” for each patient,
depending on their specific needs. This system of exercise referral is
already being used by GPs in the county, but this will be the first time
that community pharmacists will be supplying the data. Arrangements are
in place for funding to come from Camarthenshire County Council, and
it is hoped that funding from the local health board will also be secured.
Mr David believes that there is the potential for an important relationship
to develop between local councils and community pharmacies, and that
this should be further explored. “Patient testing is undoubtedly
an important role for community pharmacy,” he said, “but
barriers need to be broken down between GPs, sports centres, local councils
and pharmacies.”
In addition to schemes involving the use of local leisure facilities,
Mr David says that pharmacists are in an ideal position to help the council
with dissemination of more general information. “With the demise
of post offices, to whom does the Government look to provide information
to the community about housing or heating, for example? The obvious answer
is community pharmacy. Pharmacists are likely to have contact with elderly
people who may live on their own and who may not be getting regular meals
or have good heating, for example. Social welfare does have an effect
on health care.”
While plans are under way for these larger-scale projects to be rolled
out, Mr David still provides free lifestyle checks on an ad hoc basis.
On average he will take one blood pressure reading per day, perform four
blood glucose tests per week and one cholesterol test per week. He is
constantly giving out advice about healthy living.
“Healthy living” is also part of the national curriculum at
the local primary school, Neyland Junior School. Every year Mr David visits
the school to help the children learn about health issues. He encourages
an art competition for which children design posters about staying healthy.
Mr David’s pharmacy staff help judge the posters, which are displayed
in the pharmacy. “I hope children will pass on the key messages
to their parents,” Mr David said.
Mr David insists that what he is doing is just common sense. He hopes
that by raising awareness of coronary heart disease risk factors among
his local population, he will be able to help customers help themselves
before they become a burden to the NHS. |
The
Pharmaceutical Journal