| Obesity is an important risk factor for a number of chronic
diseases such as heart disease, stroke, some cancers and type 2 diabetes;
it is responsible for more than 9,000 premature deaths per year in England.
The Department of Health says that dealing with obesity is a Government-wide
priority.
In Coventry obesity
is being tackled with some foresight and innovation.
A new pilot study, launched last week by Coventry Teaching Primary Care
Trust (PJ, 13 January, p40), is using the skills of pharmacists to offer
lifestyle advice for people to manage their weight over the long term.
Laurence Tressler, deputy head of medicines management and community pharmacy
clinical governance facilitator at the PCT, says that it was a priority
for the trust to look at the local obesity problem.
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. Ten
pharmacies have been chosen to take part in the study, each taking on 15
patients — 150 patients in total are expected to be involved.
Local need
Coventry has a population of over 300,000 and over half of the adult
population is overweight, says Mr Tressler. “For Coventry, we’re
looking at around over 51,000 obese adults and over 11,000 obese children.
It is a big problem nationally and a big problem locally,” he
adds.
He says: “Looking at some of the data that are available, 10 per
cent weight loss can reduce blood pressure by 10mmHg, fasting blood glucose
by up to 50 per cent and total cholesterol by 10 per cent. There’s
the possibility that some of these patients are going to require less
medication for treating their conditions in the future.”
A pharmacy contract implementation team (pCIT) — set up by the
PCT to co-ordinate implementation of the community pharmacy contract — was
involved with much of the early planning. The team, chaired by Mr Tressler,
consists of members of the PCT (public health, medicines management,
best practice support, health promotion and finance departments, as well
as locality managers), the professional executive committee (PEC) pharmacist
and three representatives from the local pharmaceutical committee. Mr
Tressler emphasises that willing co-operation between all of the parties
involved has made the project happen.
The professional services team at UniChem has also played a role. The
company designed many of the service-related materials (with input from
the PCT), co-ordinated the aquisition of monitoring equipment from various
suppliers and liaised with the DoH to secure funding for the scheme — an
initial £7,500 was contributed, followed by a second £7,500
amount, the DoH has confirmed.
Mr Tressler says that there was no problem in motivating pharmacists
to become involved. He says: “Over half of the pharmacies in Coventry
wanted to take part and we had to use a robust selection technique to
obtain just 10.” Providing the service
Pharmacists have started to recruit patients to the service. John Goes,
pharmacist member of the trust’s PEC and owner of Goes Pharmacy,
has been involved with setting up the scheme and is one of the 10 pharmacists
taking part. He says that he has already recruited two patients and
knows that one of the other pharmacists has also taken on a patient.
According to Mr Goes, pharmacists are reimbursed £20 for the initial
consultation (as well as the cost of an MUR, if one is undertaken) and £15
for each consulation thereafter.
People are recruited to the service through the following routes: • Client’s own interest in losing weight
• Referral from GP
• Self referral having seen promotional material in the pharmacy
• Pharmacist’s suggestion as part of a medicines use review (MUR)
• Pharmacist’s suggestion from a conversation in the pharmacy
“We’ve been in touch with all the GP practices in Coventry,
telling them about the project, and asking them if they thought that
they had a patient that would benefit from such a scheme that they should
recommend them to go,” Mr Goes explains. He says that pharmacists
will recruit patients that they believe will be highly committed to the
programme.
Each client has 11 appointments with the pharmacist over the length of
the 12-month pilot. Mr Tressler elaborates: “Patients have an initial
meeting with the pharmacist to discuss what’s involved and they
get the chance to go away, think about it and see whether or not they
want to be part of it.”
Mr Goes says: “There is quite a lot of paperwork because the pharmacists
have to record everything that they do — this is very much like
a research project”. He explains that, as well as obtaining patient
consent, the pharmacist is responsible for monitoring and recording certain
health parameters — body mass index, waist circumference, blood
pressure, blood glucose (for people without diabetes, HbA1c (for people
with diabetes) and total cholesterol — initially for baseline measurements
and then for progress thereafter.
However, Mr Tressler highlights: “I think the thing that’s
more important is that they are going to be offered practical guidance
for support, tailored to their own individual needs, in relation to lifestyle
management.” He explains that the scheme focuses on concordance — setting
achievable goals that lead to small sustainable changes. “Clients
aim to lose 5 per cent of body weight as opposed to losing a huge amount
of weight in a relatively short period, where it just goes straight back
on again,” he points out.
Mr Goes adds: “The study is based on the idea that we work in partnership
with the patient to make small lifestyle changes. We are not trying to
say to them that you must give up everything that you are eating, because
that never works. As soon as you mention exercise to some people, they
shy away. So what we are trying to do is encourage them in smaller ways:
simpler ideas like walking for 20 or 30 minutes three to four times per
week — not saying, ‘you need to go to the gym’.”
Moving forward
Mr Tressler points out that, under the new contract, pharmacies have
a greater responsibility for delivering the promotion of healthy lifestyles. “This
has largely been interpreted and implemented as leaflets and poster
campaigns,” he says. “There is nothing at all wrong with
these but this project demonstrates that with a bit of lateral thinking
there are more exciting — and possibly effective — opportunities
out there.”
He acknowledges the need to start small, prove that it works and prove
its value. “It would definitely be an ambition that, if we can
make it work on a small scale, we’d be looking to roll it out locally
and hopefully roll it out nationally. If you look at the way the advanced
service is developing with medicines use reviews, I can see the way that
this could fit quite comfortably into this sort of model.”
Barbara Parsons, head of pharmacy practice, Pharmaceutical Services Negotiating
Committee, comments: “Obesity and obesity-linked diabetes are rapidly
growing public health problems and major Government priorities. A commissioned
diabetes targeted obesity service was identified by the PSNC at its November
planning meeting as one area in which community pharmacies can play an
effective part in tackling this problem, and we will be seeking to develop
a service within the NHS community pharmacy advanced tier.
“We have been involved with the Coventry service development from
the outset and will be following its progress with interest,” she
adds.
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The
Pharmaceutical Journal