Community Pharmacy as a setting for weight management service pilot

1. Community Pharmacy as a setting for weight management service pilot Herefordshire PCT

2. 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�

3. 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 Accessibility (time and venue); credibility (other LES); knowledge of patients; �part of community�Accessibility (time and venue); credibility (other LES); knowledge of patients; �part of community�

4. 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

5. 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

6. 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. Criteria of patient selection This was based on NICE guidance on Obesity (2006): aged 18 years or over, plus Registered with a Herefordshire GP, plus BMI over 25 with waist measurement over 94cm for men and over 80cm for women OR BMI over 25 with risk factors and co-morbidities: Type 2 diabetes Hypertension CVD Dyslipidaemia � if known, no tests to be carried out specially Osteoarthritis Sleep apnoea OR BMI over 30 irrespective of waist measurement or co-morbidities, plus Willingness and motivation to change ,and finally Not on obesity drug treatments Criteria of patient selection This was based on NICE guidance on Obesity (2006): aged 18 years or over, plus Registered with a Herefordshire GP, plus BMI over 25 with waist measurement over 94cm for men and over 80cm for women OR BMI over 25 with risk factors and co-morbidities: Type 2 diabetes Hypertension CVD Dyslipidaemia � if known, no tests to be carried out specially Osteoarthritis Sleep apnoea OR BMI over 30 irrespective of waist measurement or co-morbidities, plus Willingness and motivation to change ,and finally Not on obesity drug treatments

7. Programme design Week 1 Assessment by Pharmacist 50 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 options 10 mins

8. Training Two evening meetings for pharmacist and at least one pharmacy assistant from 5 pilot site pharmacies assessment; raising the issue; goal setting; dietary advice; behaviour change weight maintenance; physical activity; food labelling; comfort eating; follow-on support Assessment of both patient clinically and in terms of readiness to change Physical activity included use of pedometerAssessment of both patient clinically and in terms of readiness to change Physical activity included use of pedometer

9. 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

10. 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 Typo on handout � 85% female All this, as compared to the Herefordshire population NB lots of unknown occupation as retired Waist increased risk = male(>94cm) female( >80cm)Typo on handout � 85% female All this, as compared to the Herefordshire population NB lots of unknown occupation as retired Waist increased risk = male(>94cm) female( >80cm)

11. Majority of patients lost weight (82%) A third (30%) achieved the target of losing over 5% weight loss in three months Completion of the full 12 weeks of the programme appears to have been assoicated with success, with 55% of of those completing to week 12 achieving their goal of 5% weight loss, as opposed to only 5% of theose finishing before week 8 A lower weight upon recruitment aooears to have been associated with a higher chance of achieving over 5% weight loss goal, but this may change as further data is collectedMajority of patients lost weight (82%) A third (30%) achieved the target of losing over 5% weight loss in three months Completion of the full 12 weeks of the programme appears to have been assoicated with success, with 55% of of those completing to week 12 achieving their goal of 5% weight loss, as opposed to only 5% of theose finishing before week 8 A lower weight upon recruitment aooears to have been associated with a higher chance of achieving over 5% weight loss goal, but this may change as further data is collected

12. 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 Extremely statistically significant Support the view that the measurements of weight change are unlikely to be due to chance alone and that the intervention was significant on achieving the change at the end of the programme A similar scheme in Eastern and Coastal Kent only managed 24 out of 168 patients returning. Waist reduction � this represented an average loss of 10.4cm from their original Weight loss between 3-6 months less than 0.78kg if take into account all DNAs 12 month follow up under wayExtremely statistically significant Support the view that the measurements of weight change are unlikely to be due to chance alone and that the intervention was significant on achieving the change at the end of the programme A similar scheme in Eastern and Coastal Kent only managed 24 out of 168 patients returning. Waist reduction � this represented an average loss of 10.4cm from their original Weight loss between 3-6 months less than 0.78kg if take into account all DNAs 12 month follow up under way

13. 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 Recruitment = leaflets;posters;GPreferral;pharmacist raising the issue;word of mouthRecruitment = leaflets;posters;GPreferral;pharmacist raising the issue;word of mouth

14. 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��� 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