HEALTHY HEARTS IN THE WEST INITIATIVE ~
HHW COMMUNITY PHARMACY PROGRAMMES
IMPACT OF THE PROGRAMMES FOR CLIENTS
REFERRED TO THEIR GP
AND WEIGHT MANAGEMENT CLIENTS
May 2014
Healthy Hearts in the West is funded by
The Public Health Agency and Belfast Local Commissioning Group
HHW COMMUNITY PHARMACY PROGRAMMES
IMPACT OF THE PROGRAMMES FOR CLIENTS REFERRED TO THEIR GP
AND WEIGHT MANAGEMENT CLIENTS
Contents
Context
3
Overview of the Two HHW Community Pharmacy Programmes
4
Overview of Clients Referred to the GP following Vascular Risk Screening
6
Feedback from Clients: Vascular Risk Screening GP Referrals
8
Overview of Weight Management Programme Clients Followed Up
10
Feedback from Clients: Weight Management Programme
11
I would like to acknowledge and thank Ashleen Devine, the Community Pharmacy
Programme Support Coordinator for her work with clients, following up those who
participated in the HHW Community Pharmacy Programmes.
Jane Turnbull
Evaluator / Researcher Healthy Hearts in the West
May 2014
2
CONTEXT
The Healthy Hearts in the West Initiative (HHW) was established to mobilise existing
resources and assets of communities in West Belfast, and to work with health professionals
and other organisations, so that people living in West Belfast experience heart health
equivalent to the best in Northern Ireland / Europe.
In 2003 the Department of Health highlighted that pharmacists are the biggest untapped
resource for health improvement. Pharmacies are located in the ‘heart of communities’, and
are well placed to make an important contribution to improving public health and the wider
promotion of health.
Two Community Pharmacy Programmes, aiming to reduce risk factors to heart health, have
been piloted in West Belfast, linking into the Healthy Hearts in the West Initiative. The
Vascular Risk Screening and the Weight Management Programme are promoted and
delivered by ten Pharmacies in West Belfast. Delivery of the HHW Community Pharmacy
Programmes was supported by the Ulster Chemists Association.
One of the most effective ways to evaluate the impact of the HHW Community Pharmacy
Programmes is to collect data about ‘what happened next’ for those clients who were
referred to their GP, and follow-up with clients who participated in the Weight Management
Programme.
In March 2014 (following a meeting including representation from the Pharmacists, the Ulster
Chemists Association, the Public Health Agency, and Healthy Hearts in the West) it was
agreed that there would be significant benefit in undertaking follow-up telephone interviews
with clients to ascertain the outcome, and therefore personal impact, of the Community
Pharmacy Programmes. It was agreed that the focus should be with clients who Pharmacists
asked to self-refer to their GP following potentially high risk health check results, and also to
talk with clients who completed the Weight Management Programme (and also those who
did not complete the six-month Programme to ascertain their reasons for non-completion).
This Report presents the feedback from Follow-Up telephone interviews undertaken by the
Community pharmacy Programme Support Coordinator in February and March 2014.
3
OVERVIEW OF THE TWO HHW COMMUNITY PHARMACY PROGRAMMES
Ten pharmacies engaged in delivery of the HHW Community Pharmacy Programmes,
located within the HHW Hub areas as follows:
Greater Falls Hub area (five pharmacies)
 Boots the Chemist
 James McDonagh Pharmacy
 McGettigan’s Pharmacy
 Rockville Pharmacy
 T A Maguire Pharmacy
Upper Falls Hub area (three pharmacies)
 Doherty’s Pharmacy Ltd
 McGraths Pharmacy
 Woodbourne Pharmacy
Close to the Upper Falls Hub area (two pharmacies)
 Laurel Glen Pharmacy
 Dairy Farm Pharmacy
The Pharmacists involved with the HHW Community Pharmacy Programmes were expected
to follow the same specification and protocols; they had all purchased the same equipment;
and completed comprehensive Client Record Forms (developed in consultation with the
Public Health Agency, who also collated data and provided the numerical data analysis for
the first fourteen months of the Programmes).
Basic criteria were established for those wishing to participate in the Programmes. Vascular
Risk Screening is open to all adults aged over 45 years; the Weight Management
Programme can be accessed by anyone over 18 years with a BMI of 30 or more.
Clients with potentially at-risk health check results were advised by the Pharmacists to make
an appointment with their GP. Pharmacists also signposted clients to:
 The Healthy Hearts Hubs (Lower Falls, Upper Falls and Upper Springfield)
 The Weight Management Programme (following the Vascular Risk Screening, when the
clients BMI measured 30 or greater (ie ‘obese’)
 Smoking Cessation Programmes
 Specialist agencies.
Pharmacists delivering the Programmes engaged with individuals raising awareness and
advice on diet, physical exercise, alcohol, and smoking to support lifestyle change. In 2014
the Pharmacists were given a range of resource materials produced by the British Heart
Foundation.
4
The Vascular Risk Screening and the Weight Management Programmes were promoted
through posters, leaflets, word of mouth (referrals from the community sector and
recommendation from family and friends), and through promotional activity at fifteen Health
Events.
Vascular Risk Screening
The Vascular Risk Screening Programme offered a one-to-one consultation with the
Pharmacist; and a series of health checks, namely: Blood Pressure, Glucose (Blood Sugar),
Cholesterol, Body Mass Index (BMI), and Waist Circumference.



757 people have accessed the Community Pharmacy Vascular Risk Screening
131 people have been referred to their GP with potentially high-risk health check results
253 people were signposted by Pharmacists to community heart health programmes.
A number of people referred to their GP took part in a short follow-up survey. A high majority
had been prescribed medication, predominantly for high blood pressure, but also due to
other at-risk health results. A minority were referred to health specialists (for example, due to
diabetes).
Weight Management Programme
The HHW Weight Management Programme required clients to engage over a six month
period. Following the initial one-to-one consultation and health checks, clients were expected
to visit the Pharmacy for regular ‘weigh –ins’ using the Keito Machine (which they could
personally access); and be able to access advice and support from the Pharmacist (who had
all received training in Motivational Interviewing Techniques).


104 people enrolled on the Community Pharmacy Weight Management Programme
76 people have completed the Programme; and the majority who completed, have lost
weight.
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OVERVIEW OF CLIENTS REFERRED TO THE GP FOLLOWING VASCULAR RISK
SCREENING
As noted above, total of 162 clients were referred to their GP following the health checks. In
February and March 2014 the Pharmacy Support Coordinator carried out a series of followup telephone interviews; using a short interview form (adapted from the PHA Farm Families
Health Checks Follow-Up model).
The Community Pharmacy Vascular Risk Screening and Weight Management Specification
states that referral to the GP is required if:
 Client’s blood pressure exceeds systolic BP 160 mmHg and / or diastolic BP 90 mmHg
 If the client is known to suffer type 2 diabetes the ‘at-risk’ reading is deemed to be
systolic BP 145 mmHg and / or diastolic BP 85 mmHg
 Total blood cholesterol concentration is 7.00 mmol/L or greater
Additionally, Pharmacists referred clients to their GP when their Blood Glucose reading was
greater than 8.00 mmol/L (note: this figure was not included in the manual as it was thought
that different commissioners might wish to define alternative referral criteria. This is the
criterion that is used within the HHW Community Programme health checks, and was
detailed to the Pharmacists on the training day).
The Pharmacy Support Coordinator sought to contact 51 clients who were referred to their
GP by the Pharmacist following the Vascular Risk Screening. The table below shows that
contact was made with 26 clients.
No. of Clients
Referred Pre-April 2013
12
Referred between April 2013 to January 2014
No response after three phone calls (post-March 2013)
14
3
Insufficient contact details (post-March 2013)
Total
22
63
The table below presents the Pharmacy that referred the clients to the GP following
participation in the HHW Community Pharmacy Vascular Risk Screening Programme.
Pharmacy
Pre April
2013
Dairy Farm Pharmacy
Boots the Chemist
Doherty’s Pharmacy Ltd
James McDonagh Pharmacy
3
-
No. of Clients
April 2013
Insufficient
to January contact info
2014
6
2
-
2
2
-
No
response to
phone call
6
Pharmacy
continued
No. of Clients
Pre April
2013
April 2013
to January
2014
Insufficient
contact info
No
response to
phone call
Laurel Glen Pharmacy
McGettigan’s Pharmacy
9
-
3
-
2
2
-
T A Maguire Pharmacy
McGraths Pharmacy
-
3
2
2
2
Rockville Pharmacy
Woodbourne Pharmacy
Total
12
14
2
8
22
1
3
The table below shows the reason for Pharmacist referred the client to their GP (as recorded
on the Client Record Form).
Reason for Pharmacist Referring
the Client
to their GP
Contact
made with
the client
No. of Clients
Insufficient No response
contact
to phone
info
call
Total No.
of clients
Cholesterol level
Blood Pressure
BMI / weight
Blood Sugar and BMI
Blood Pressure and BMI
Blood Sugar
Cholesterol level and BMI
Blood Sugar & Cholesterol level
6
7
5
4
3
1
2
4
4
3
3
1
4
1
2
1
-
12
11
9
7
4
4
2
2
Unknown
Weight, Cholesterol & Blood Sugar
-
2
1
-
2
1
As the table shows, the highest numbers of referrals were due to high cholesterol results,
followed by blood pressure and BMI readings. The table also shows that 15 clients had two
potentially high-risk health check results and 1 had three high-risk health factors.
7
FEEDBACK FROM CLIENTS: VASCULAR RISK SCREENING GP REFERRALS
All 26 clients who were referred to their GP following the Vascular Risk Assessment, with
whom contact was made, were asked whether they took the referral advice of the
Pharmacist and made an appointment to see their GP.
Client reported that they made an
appointment and saw their GP
Referred Pre-April 2013
Referred between April 2013 to January 2014
Total
No. of Clients
Male
Female
3
4
7
4
4
8
Therefore, of the 26 clients who were referred to the GP 15 saw their GP and 11 did not (4
males and 7 females).
Some clients explained why they had not made an appointment with their GP:
 Started Weight Watchers – already on prescription drugs for cholesterol (reason for
referral)
 Has regular appointments with the GP and now feels the healthiest he has been for a
year; also started running
 Too scared to go to the GP; takes painkillers, and believes blood pressure is alright
(Pharmacist reported it as very low)
 Did not go because her husband died
 Has lost some weight; also went to the Royal Victoria Hospital and checked weight there,
advised by the Nurse that the weight was ok
 Already on medication for blood pressure (referred due to high blood pressure reading)
and has regular appointments with the GPHas porridge in the morning now (referred
because of cholesterol levels)
 Plans to attend (referred in December 2013); but intends to go back to the Pharmacist
first to recheck health results (referred because of cholesterol levels).
The table below provides an overview of the outcome of the 15 clients who saw their GP
Outcome of GP Appointment
Referred to Specialist Service
Review /Commencement of Medication
Health Promotion Advice Given
No action taken by GP
No. of clients
1
8
10
5
Clients gave additional information about the outcome of their appointment with the GP. This
has been categorised as no action taken by GP, action taken by GP in relation to
medication, and lifestyle changes.
8
No action taken by GP
 The Doctor said that blood pressure and cholesterol health results (reasons for referral)
were fine x 2 responses
 Blood pressure is fine and has remained fine (referred with high blood pressure)
Referred because of blood sugar and BMI results – already taking tablets for cholesterol.
Sees GP regularly because suffers from depression
Action taken by GP in relation to Medication
 Taken off Beta-Blockers (blood pressure was low and falls)
 Started medication for blood pressure (Penndopril, 2mg and statins – client only has one
kidney) has lost 18.5 kilograms
 Put on medication for blood pressure and cholesterol (Simvastatin)
 Was given tablets for cholesterol; but forgets to take them and doesn’t go back to the
GP; has not stopped smoking
 Started on statins (referred because of cholesterol level) and has a review with the GP
later in the month
Changes in Lifestyle
 Doesn’t want to start medication (referred because of cholesterol health check result);
instead has changed diet, including no butter and no chips
 Everything fine; no medication. Has started going to the gym.
Some clients also engaged with the Healthy Hearts Hubs, and made lifestyle changes;
examples given included
 Seeking advice from the Healthy Hearts Hub Coordinator
 Joining a HHW walking club
 Starting physical exercise programme
 Taking part in a healthy eating programme
 Going to the Leisure Centre (circuits, spin class
During the telephone interviews the Pharmacy Community programme Support Worker gave
clients advice. This included:
 Clients advised to make an appointment to see the GP
 Discussion with clients about opportunities to engage in physical exercise
 Signposted clients to smoking cessation programme
 Gave clients Healthy Hearts Hub Coordinator details
 Signposted clients to healthy eating programme.
9
OVERVIEW OF WEIGHT MANAGEMENT PROGRAMME CLIENTS FOLLOWED UP
In addition to the clients contacted (or with whom contact was attempted to be made)
because the Pharmacist referred them to their GP; a further 9 clients who had participated in
the HHW Community Pharmacy Weight Management Programme were included in the
follow-up telephone contact process. Contact was made with 8 of the 9 clients. All 9 clients
had participated in the Weight Management Programme at T A Maguire Pharmacy.
The table below shows the client’s initial weight, final recorded weight, weight loss, and
whether or not they engaged in the Programme for the recommended six months. Weights
recorded in stones and pounds were converted into kilograms in order to present similar
data). The last client in the table is the person with whom contact was not made.
1
2
3
4
5
6
7
8
9
Male
Female
Male
Male
Male
Male
Female
Female
Female
Initial
weight
recorded
115.9kg
84.5kg
92.9kg
111.0kg
112.0kg
101.6kg
66.0kg
97.8kg
98.4kg
Final
weight
recorded
106.8kg
86.0kg
81.2kg
104.2kg
106.0kg
93.9kg
66.0kg
93.5kg
89.4kg
Total
weight loss
- 9.1kg
+ 1.5kg
- 12.7kg
- 6.8kg
- 6.0kg
- 7.7kg
No change
- 4.3kg
- 9.1kg
Engaged
for six
months
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Unknown
As the table shows:
 5 clients were male and 4 were female
 7 clients completed the six month Programme; 1 client left before the recommended six
months, and it is unknown whether the client with whom contact was not made
completed the Weight Management Programme
 7 clients lost weight; 1 client gained weight, and for 1 client there was no change in
weight (this client did not complete the Programme.
Additional data provided records that the client who did not complete the Programme, and
for whom there was no weight change was referred to her GP by the Pharmacist due to high
Blood Sugar level results. She was subsequently diagnosed with diabetes; which she felt
was more of a priority to address at the time than losing weight.
10
FEEDBACK FROM CLIENTS: WEIGHT MANAGEMENT PROGRAMME
The 8 clients interviewed who had engaged with the Weight Management Programme were
asked whether they attained their goal in terms of weight loss. As the table below shows;
half of them felt they had achieved their goal, and the other half said they did not achieve
their goal. No one said that they had exceeded their goal in relation to weight loss.
Clients Attained Goal in
terms of Weight Loss
Yes exactly
Yes exceeded
No
4
-
4
One client said that it was “motivation” that helped them to achieve their goal.
The clients were asked whether they had an future plans in terms of weight loss, and were
given three options in relation to exercise, diet and nutrition, and wishing to lose more
weight. Client feedback is given in the table below.
Future Plans
Yes
No
u/k
Do you plan to carry on taking exercise?
4
3
1
Do you plan to watch what you eat?
7
-
1
Do you want to lose any more weight?
5
1
2
In what way?
Walking
Running
Eating fruit and vegetables
Joined Weight Watchers
Joined Weight Watchers
4 clients reported that the GP referred them to their GP:
 Cholesterol level high – reduced by changing diet
 Cholesterol and blood sugar health check results high; diagnosed as a diabetic and on
Simvastan for cholesterol (which has now reduced)
 Referred because of high blood pressure and cholesterol level; but these have both
reduced with weight loss – 12.7 kilograms
 Put on medication for blood pressure and high cholesterol (Co-amitozide, bendro and
statin) – also had a TIA
Pharmacists had referred 6 of the people interviewed to the Healthy Hearts in the West
Community Hub. 3 of them made contact with the Hub Coordinator.
 3 engaged in diet, nutrition, or healthy eating programmes
 2 engaged in physical activity programmes
Clients gave feedback about lifestyle changes they had made following advice given by the
Pharmacist. This included:
 Changed diet (no bread, no potatoes, no sandwiches, increased fruit and vegetable
intake, eating fibre and wholemeal, homemade soups, stopped eating chocolate, diet
coke, no salt in diet
 Taking more exercise (walking, gym
11



Gave up smoking
Weigh self at home now
Reduced alcohol intake
Additional comments recorded during the interviews included:
 “I am still conscientious and eat breakfast, lunch and dinner, with fruit as a snack”
 “Although I lost 7.7 kilograms, I have put almost 4.5 kilograms back on six months after I
stopped the Programme”
 “I was told about the Hubs; but have made changes for myself. I watch what I eat, no
fatty foods, cut potatoes out, eat everything in moderation, and eat lots of fruit and
vegetables (more than five portions a day)”
 “I reduced my cholesterol level by changing my diet”.
 “The Weight Management Programme gave me the incentive and I put more effort into
losing weight”.
12