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Community Pharmacy Weight Management Service April 2009 Protocol Notes PREPARED BY: UNICHEM LTD PROFESSIONAL SERVICES DIVISION Acknowledgements Acknowledgment is given to all participating and supporting organisations, including NHS Nottingham City and it’s participating pharmacies: Special acknowledgment is also given to the following individuals who contributed towards the development of this programme: Dr Terry Maguire 2 Contents Introduction Page 4 Obesity and NHS Nottingham City 4 NHS Nottingham City Vision 5 The Role of Community Pharmacists 6 Weight Management Service: o o o o o o o o Aim Objectives Outcome Measures Pharmacy & Pharmacist Selection Patient Inclusion Criteria Patient Exclusion Criteria Patient Recruitment Numbers Confidentiality & Data Protection 7 7 7 7 8 8 8 8 Methodology o o o o o o o GP Briefing Service Process Role of Pharmacy Support Staff Pharmacist Intervention & Referral Criteria Data Flow Service Equipment Clinical Governance 9 9 9 11 11 12 12 Service Flowchart 14 Management of documentation 15 Patient Booklets 16 Timeframe 16 Remuneration 16 Contact Details 16 References 17 Appendix 18 o Participating Pharmacies o Advice & Recommendations Section o Sample Documentation 19 21 34 Introduction Impact of Obesity Over half the UK population are now either overweight or clinically obese, and according to latest reports, if current trends continue at least one-third of adults, one-third of girls and one-fifth of boys could be clinically obese by 20201. Obesity is now well recognized as a disease in its own right, and is largely preventable through changes in diet and lifestyle. However, it is clearly established that being overweight or obese increases the risk of coronary heart disease (CHD), cancers, diabetes, hypertension, stroke, respiratory problems and osteoarthritis, and is associated with a reduced life expectancy. As well as these debilitating conditions, being overweight or obese can have detrimental effects on self-esteem and social life. Worldwide, around 58% of Type-2 diabetes, 21% of CHD and between 8% and 42% of certain cancers are attributable to excess body fat. In England alone, obesity is responsible for more than 9000 premature deaths each year, reducing life expectancy on average by nine years2. The financial cost to the NHS is estimated to be around £500m a year in treatment costs3. The use of anti-obesity drugs, under NICE guidelines4, has trebled since 2001 putting increased pressure on drug budgets. The NHS Plan5 makes a commitment to improve the overall balance of the diet and increase the activity of the population. The benefits of weight loss are well documented6 and setting realistically achievable targets is important. Just a 10% weight loss can reduce: Mortality by up to 25% Blood pressure (systolic and diastolic) by 10mmHg Diabetes risk by over 50% Fasting blood glucose by up to 50% HbA1c by 15% Total cholesterol by 10% Obesity and Nottingham City PCT Currently in Nottingham City an estimated 84 000 men and women are overweight and an additional 47 000 men and women are obese (body mass index ≥30 kg/m2), with a higher level of obesity in the more deprived wards than in the more affluent areas of the city. Diseases related to overweight and obesity are estimated to cost Nottingham City PCT £85.1M, rising to £88.3M in 2010, and £94.4M by 2015.VIII. 4 The Role of Community Pharmacists and their Support Staff A well-informed, motivated community pharmacy team is appropriately placed to play a central role in providing advice and ongoing support for overweight and obese people. The strategy for tackling overweight and obesity needs to incorporate a number of factors: Ready access to advice and support Publicising the benefits of weight management Inter-professional collaboration Ongoing support and monitoring Causes of Overweight and Obesity: Underlying cause of overweight and obesity is where an individual has an excess of energy intake over energy expenditure Calorie intake greater than calorie burn-up Other associated factors include: Behavioural Environmental Social Genetic Community pharmacists and their staff are an integral part of the primary healthcare team. It has been widely recognised that better use can be made of their skills and knowledge for the successful provision of high quality, patient-centred services and the rational, cost-effective use of medicines. The Pharmacy White Paper, Pharmacy in England: building on strengths - delivering the future (April 2008) identified the need for healthcare professionals to work together more closely to demonstrate seamless patient care through the development and implementation of Enhanced Services at a local level. 5 Weight Management Service Aim To provide a weight management service for overweight and obese patients: - Defined as having a BMI ≥30kg/m2 and/or - Increased Waist Circumference – Male 102cm (40ins) & Female 88cm (35ins) NB: The waist circumference for Asian men should be below 90cm (36 inches) & Asian women should be below 80cm (32 inches) Objectives To facilitate a weight loss of at least 5% in obese patients To identify obese patients “at-risk” of developing long-term conditions To educate patients in healthy living To explore the role of community pharmacists and their support staff in the primary health care team and the extension of that role into the provision of clinical pharmacy services To explore the potential to extend the role of community pharmacists and their support staff in weight management Outcome Measures Number of recruited patients achieving a weight loss of ≥5% of recruitment weight Nature and number of pharmacist / support staff interventions Number of people identified “at-risk” of developing a long-term condition Number and nature of referrals to GPs Nature and number of patients referred to community pharmacies by GP practices Assess patient and pharmacist team satisfaction with the scheme Pharmacy & Pharmacist Selection The service will involve twenty five community pharmacists selected by NHS Nottingham City (see list of participating pharmacies on Page 19) using the following criteria to ensure optimal service delivery and output: Pro-active pharmacy staff member enthusiastic about opportunity presented by programme who will be supported by their pharmacist Pharmacy has consultation area that has been verified during monitoring visits to meet contract specification Pharmacy has achieved a satisfactory contract monitoring report 2007-8 Pharmacy has demonstrated through past performance that it will actively engage and support local intimates and services Suitable pharmacy location (to ensure good geographical distribution) Commitment to time by pharmacy staff for service implementation and delivery including involvement from at least one named member of pharmacy staff to attend the training event(s) and facilitate service delivery. 6 Patient Selection Criteria Patient Inclusion Criteria The service will be offered on an opportunistic basis to patients meeting the following criteria: Adults over 18 years age Adults with a BMI and/or Increased Waist Circumference – Male 102cm (40ins) & Female 88cm (35ins) Patient Exclusion Criteria Patients with the following criteria will be excluded from the programme: Adults under the age of 18 years Adults with a BMI <30kg/m2 Pregnant or breastfeeding women Where in the pharmacist’s professional opinion, the poor state of health of the patient should preclude their participation as it would not be in the patient’s best interest to take part Patients who are not suitable for inclusion onto the programme can be signposted to the local services (contact details provided on Page 16). Patient Recruitment Numbers Each pharmacy will recruit 20 patients onto the programme for a 12-month duration. The initial intervention is anticipated to involve the pharmacist and/or their support staff for approximately 40 minutes. Pharmacy support staff will run the service after appropriate training, under the supervision of a trained pharmacist Patients may be recruited onto the programme by: Self – referral by suitable patients who meet the above inclusion criteria Referral through GP surgeries for patients who have volunteered/expressed an interest in the programme Pharmacists/Pharmacy Staff to refer suitable patients onto the programme through prescription interventions and medicines-use-reviews Opportunistic recruitment of suitable patients Confidentiality & Data Protection The pharmacy is registered under the Data Protection Act 1998, its predecessor Act and the RPSGB Code of Ethics (see Medicines, Ethics and Practice: A Guide for Pharmacists and www.rpsgb.org.uk). Data will be analysed by UniChem Professional Services in an anonymised encrypted form at 3, 6 and 9 months and a final report at 12 months. No information that can identify the patient or GP will be made available to any third party. 7 Methodology Service Process for New Patients A flow diagram of the service process is included on Page 13. The pharmacy will deliver the programme as follows: 1. Identify suitable patients as per inclusion and exclusion criteria 2. Provide patient with a service Patient Information Leaflet 3. Once patient has expressed an interest, obtain patient’s written consent utilising the Patient Consent Form 4. Conduct a baseline assessment for the patient, which includes completing the Patient Recruitment Form and measuring the following monitoring parameters: - Weight Body Mass Index (BMI) Waist Circumference Blood Pressure 5. Document the outcome of subsequent assessments onto the Patient Follow-up Form 6. Provide patient with relevant information leaflets as per visit number 7. Provide patient with a Food and Exercise Daily Diary, Appointment Card and patient information booklet. 8. Set targets for diet and exercise. Aim for a 5% weight-loss overall for the service duration 9. Refer to the GP Practice if any results fall outside the recommended guidelines as per NHS Nottingham City recommendations 10.Book the patient in for follow-up assessment(s) as outlined in the table: Visit No. Week No. Recruitment 0 weeks 1 2 Action Plan Record the patient’s baseline weight, BMI and waist circumference Record their blood pressure Assess their commitment to losing weight Explain the health benefits of losing weight Discuss their diet and explore possible changes Discuss their physical activity and possible changes to increase their daily level of physical activity Agree a realistic, achievable target weight and lifestyle goal for the next 6 – 12 months Give them a food and activity diary and encourage them to complete it for their subsequent visits Identify and agree goals for the next visit 2 weeks Review and record the patient’s weight, BMI, waist (fortnightly) circumference and blood pressure Review their food and physical activity diary Discuss portion size and calories Discuss continuing their physical activity Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit 4 weeks Review and record the patient’s weight, BMI, waist (fortnightly) circumference and blood pressure Review their food and physical activity diary Discuss food types and groups (The eat well plate) 8 3 8 weeks (monthly) 4 12 weeks (monthly) 5 16 weeks (monthly) 6 20 weeks (monthly) 7 24 weeks (monthly) 8 28 weeks (monthly) Discuss identifying leisure facilities and increasing their physical activity Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss alcohol intake and associated calories Discuss the physical activity increases Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss choosing, buying and cooking food Discuss their physical activity Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss salt intake and daily consumption of water Review their physical activity and suggest appropriate changes Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss food labels – guideline daily amounts and multiple traffic light labelling systems Discuss physical activity changes made and their impact Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss food labels – guideline daily amounts and multiple traffic light labelling systems Review their progress to-date against target at recruitment Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Review impact on lifestyle and quality of life of changes made to-date Review physical activity Consider referral to other healthcare professionals, if required 9 9 32 weeks (monthly) 10 36 weeks (monthly) 11 40 weeks (monthly) Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Discuss maintaining their healthy weight (top tips for weight management) Review physical activity Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Review and record the patient’s weight, BMI, waist circumference and blood pressure Review their food and physical activity diary Look at maintaining their healthy weight (top tips for weight management) Review physical activity Consider referral to other healthcare professionals, if required Set new goal(s) for next follow-up visit Final record of weight, BMI, waist circumference and blood pressure Discuss maintaining their healthy diet and physical activity (Self-help measures) Patient signed off from service Role of Pharmacy Support Staff The pharmacy support staff play a crucial role in patient recruitment and in running the scheme. Once appropriately trained and competent, support staff will be able to run the community pharmacy weight management service under the supervision of trained pharmacist. Pharmacist Intervention & Referral Criteria For patients whose blood pressure is not currently being monitored by their GP and who are not currently prescribed antihypertensive medications the referral trigger point is a blood pressure measurement of over 140 / 90mmHG on 3 consecutive visits, in line with NICE guidance. Pharmacists may wish to refer those with significantly raised BP more urgently. In general, patients will be responsible for making their own appointment with their practice. Urgent referrals will be made by telephone by the pharmacist to the relevant practice and followed up by documentation. The above parameters follow NICE recommended guidelines. Individual patient parameters may vary depending on guidance provided by the patient’s GP, and should be borne in mind when providing feedback to the patient. The pharmacist / pharmacy staff member should utilise their professional discretion when interpreting results. Data Flow Data from the monitoring parameter measurements are captured on the Patient Assessment Form (sample provided on Page 29). Patients will be provided with a record of the outcomes by the pharmacists. Green copies of the Patient Assessment Form documenting results or suitable annotations should be returned to UniChem Professional Services at the end of each week. 10 White copies should be given to the patient and Yellow copies are to be retained in the pharmacy for 7 years. Data will be captured anonymously by UniChem Professional Services. The data will be analysed and form the basis of the monthly reports to facilitate payments to the participating pharmacies and provide a means of capturing the required outcomes of the service. Service Equipment Monitoring Parameter Weight BMI Body Mass Index (BMI) Waist Circumference Blood Pressure Equipment Weight & BMI Scales Weight & BMI Scales Weight & BMI Scales Tape Measure Omron M7 Meter Supplier Seca Seca Seca Omron UK All participating pharmacists and their staff must be trained in the correct use of the equipment by the appropriate supplier, before commencing the service. All staff have to sign a PCT document to confirm they have undertaken the training before they commence the service. The standard operating procedures for all equipment will be supplied before the start of the service. Pharmacists may delegate this element of the service to their support staff after appropriate training, but will remain ultimately responsible for any outcomes. Clinical Governance Additional NHS Nottingham City guidelines on Infection Control and Hygiene folders have recently been distributed to all pharmacies. Participating pharmacies must ensure that these guidelines are followed. All adverse events should be reported to Sally Seeley, Clinical Governance Manager at NHS Nottingham City, Standard Court, Nottingham, NG1 6GN in writing within 48 hours using the standard PCT Incident reporting form. 11 Weight Management Service Flowchart Identify suitable patients through - PMR - MURs/Px Interventions - Self-Referrals - Opportunistic identification Patient AGREES to participate Invite patient to participate in service Give patient a Programme Information Leaflet if they do not wish to participate Provide patient with a Patient Information Leaflet & complete Patient Consent Form Conduct appropriate Assessment & Monitoring Parameters measurements and record onto Patient Assessment Form Provide patient with - Food & Exercise Diary - Appointment Card - Action Plan - Appropriate visit leaflet Refer patient to appropriate healthcare professional as per programme protocol Invite patient for follow-up appointment 12 Management of documentation On each Patient Form, you must enter: Your pharmacy details & ID Patient ID (ideally PMR No.) Date of measurement(s) Patient Consent Form Completed by patient at recruitment Give top WHITE copy to patient Retain bottom YELLOW copy in pharmacy DO NOT SEND to UniChem Professional Services Patient Assessment Form Completed at baseline assessment and at follow-up appointments Forward GREEN Copy to UniChem Professional Services Give WHITE Copy to the patient Retain YELLOW Copy in pharmacy GP Referral Form Completed when patient referred to GP or another healthcare professional, at initial or follow-up appointments Forward GREEN Copy to UniChem Professional Services Forward YELLOW Copy to GP/Healthcare Professional Retain WHITE Copy in pharmacy 13 Please return all completed GREEN copies of documentation to UniChem Professional Services at the end of every week in the freepost envelopes provided. Patient Booklets Some copies of the booklet “Sustaining healthy weight loss” produced by Ben Langston, UniChem Professional Services are provided in the support pack. Additional copies and service materials can be ordered by contacting Ben Langston on Tel No: 020 3044 8437, or e-mail: [email protected]. Timeframe May 09 Jun 09 Jul 09 Aug 09 Sept 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Training GP Briefing Within 2 weeks of training Patient Recruitment Patient Followup Remuneration NHS Nottingham City will make payments on a monthly basis, 3-months after commencement of the programme. In order to ensure timely and accurate payments, completed documentation should be forwarded to UniChem Professional Services on a weekly basis. Remuneration for pharmacist participation has been determined by the PCT at: Baseline Assessment Fee of £20 (inclusive of VAT) per patient Follow-up Fee of £12 (inclusive of VAT) per patient Contact Details All queries regarding the delivery of this service (e.g. clarification on protocol or completion of documentation) should be made in the first instance through your PCT contact: Caroline Badder Medicines Management Project Co-ordinator NHS Nottingham City Tel: 0115 8839388 E-mail: [email protected] Richard Balcon NHS Services Manager, UniChem Professional Services Tel: 0788 7722452 Email: [email protected] UniChem Professional Services FREEPOST SEA5263, Chessington, Surrey, KT9 1BR 14 References 1. “Storing up problems – The medical case for a slimmer nation”, Royal College of Physicians, February 2004, www.rpclondon.ac.uk 2. WHO. Obesity: preventing and managing the global epidemic. Geneva 2000. www.who.int/nut/publications.htm 3. NAO. Tacking Obesity in England. www.nao.gov.uk 4. NICE. Guidance on the use of Orlistat (No.22) and Sibutramine (No.31). 2001. www.nice.org.uk/article 5. DoH. The NHS Plan: a plan for investment and reform. 2000. www.doh.gov.uk/nhsplan 6. Jung RT. Obesity as a disease. Br Med Bull 1997; 53:307-21 15 Appendix Advice and Recommendations: Details of Participating Pharmacies Goals and Recommendations in the management of diabetes Weight Management Lifestyle Advice Exercise Referral Programme Expert Patient Programme Measuring Blood Pressure (MHRA Guidelines) RPSGB Guidelines Useful Resources Process Document Examples: Patient Information Leaflet Patient Consent Form o Patient Assessment form o GP Referral Form o Patient Follow-up Form o o 16 Participating Pharmacies Pharmacy Name Carrington Pharmacy Radford Road Pharmacy Jaysons Pharmacy Boots UK Ltd Asims Chemist Medina Chemist Mistry's Pharmacy Sainsburys Pharmacy Boots UK Ltd Boots UK Ltd Burrows & Close Ltd Boots UK Ltd Lloyds Pharmacy Coop Pharmacy Coop Pharmacy Coop Pharmacy Boots UK Ltd Boots UK Ltd Glasshouse Chemist Lloyds Pharmacy Boots UK Ltd Knights Chemist Boots UK Ltd Pharmacy Address 351 Mansfield Road, Carrington, NG5 2DA 544 Radford Road, Basford, NG7 7EA 97 Arleston Drive, Wollaton, NG8 2GB Unit A, Riverside Retail Park, Queens Drive, NG2 1GS 14-16 Colwick Road, Sneinton, NG2 4BU 85-87 Radford Road, Hyson Green, NG7 5DR Units 3-4 Top Valley Way, Top Valley, NG5 9DD Castle Bridge Road, Castle Marina, NG7 1GX 71 Bracebridge Road, Bilborough, NG8 4PH 10 Broxtowe Lane, Cinderhill, NG8 5NP 72 Ilkeston Road, Radford, NG7 3GQ 40 Listergate, 2 Broadmarsh Centre, NG1 7LB 113 Sneinton Road, Sneinton, NG2 4QL 6 Robin Hood Chase, St Anns, NG3 4EZ 12 Harrow Road, Wollaton, NG8 1FG Hucknall Road, Kibworth Close, Heathfield, NG5 1NA 1-3 Commercial Road, Bulwell, NG6 8HD 222-224 Southchurch Drive, Clifton, NG11 8AA Telephone No. 42-44 Glasshouse Street, NG1 158 Russell Drive, Wollaton, NG8 2BE 0115 9480658 54 Long Row West, NG1 6HL 1 Knights Close, Top Valley, NG5 9AJ 541 Aspley Lane, Aspley, NG8 5RW 0115 9587341 0115 9605453 0115 9782336 0115 9284563 0115 9864182 0115 9480865 0115 9790700 0115 9752466 0115 9484595 0115 9292316 0116 9786928 0115 9783389 0115 9507381 0115 9504938 0115 9504951 0115 9289256 0115 9604140 0115 9278057 0115 9215630 0115 9282831 0115 9277948 0115 9291009 17 Weight Management Body Mass Index Body Mass Index, BMI, is measure of body fat based on height and weight that applies equally to adult men and women. It is calculated by the following formula using an individual’s height (in metres) and weight/ mass (in kilograms): BMI = Weight (Kg) [Height (m)]2 It can be used to determine whether an individual falls into a broad band considered to be healthy weight, or if falling outside these parameters, to what extent, and is therefore a useful way of calculating whether an individual needs to loose weight as indicated below: BMI <19kg/m2 19-25 kg/m2 25-30 kg/m2 >30kg/m2 Category Additional Information This indicates a low amount of body fat. These Underweight individuals may lose their immunity and you should consider gaining weight through good diet and exercise habits, to increase muscle mass. Normal This indicates an acceptable amount of body fat, which is associated with the lowest incidence of serious illness. Overweight These individuals are considered ‘hefty’ and should be advised to find ways to lower their weight through diet and exercise. Obese These individuals are considered ‘unhealthy’. Their excess body weight puts them at increased risk of heart disease, diabetes, high blood pressure, and some cancers. Individuals should be advised to loose weight by changing their diet and exercising more. Waist Measurement BMI is not a definitive measure of weight management and should be used together with waist measurement to capture the ‘apple’ shaped patient. Guidelines for adults are as follows: Men should be below 102cm (40 inches) Women should be below 88cm (35 inches) Asian men should be below 90cm (36 inches) Asian women should be below 80cm (32 inches) 18 Benefits of weight loss Weight loss is associated with significant health benefits: Benefits of 10kg (10%) weight loss in a 100kg subject Mortality Blood pressure Lipids Diabetes 20-25% decrease in premature mortality 10mmHg decrease in systolic pressure 20mmHg decrease in diastolic pressure 10% decrease in total cholesterol 15% decrease in LDLcholesterol 8% decrease in HDLcholesterol 30% decrease in triglycerides 50% reduction in risk of developing type 2 diabetes 30-50% decrease in elevated blood glucose 15% decrease in HbA1C Impact of obesity on health o Independent risk factor for premature death o Morbidity associated with obesity can be divided into metabolic, mechanical and psychological disorders: Metabolic disorders: cancers (breast, colon); reproductive Mechanical problems: Diabetes Hyperlipidaemia Hypertension Stroke; gallstones; some problems (PCOS, infertility) Osteoarthritis Chronic back pain Shortness of breath Sleep apnoea Psychological problems Depression Low self esteem It is vital to establish an empathetic, non-judgemental relationship with an overweight patient in order for intervention therapy to be successful. 19 Dietary treatment for overweight/obese patients Assessment Most active treatment is usually directed at those at highest risk, as determined by: o o o o o o Current BMI Waist circumference Concurrent morbidity (Type 2 Diabetes; hypertension) Family history of obesity-related morbidity Physical inactivity Psychological disturbance Background information Try to assess some or all of the following issues: o o o o o o o Family circumstances; occupation; etc. Expectations Motivation Confidence Knowledge Weigh history Previous dieting Dietary information Try to assess the following: o o o o o o o o Meal; pattern: regular meals or snacks Preferred foods: sweet or savoury Food dislikes ‘Hard to resist’ foods Portion sizes Cooking arrangements Cooking facilities Eating Disorder (e.g. binge eating) Treatment plan Standardised diet sheets are of no value. Aim instead for: Long-term change in: Eating habits Attitudes to eating Eating behaviours Discuss & agree with the patient a small number of changes that they could make to their diet in order to achieve better health and weight loss. o It requires a 500 kcal/day deficit to achieve a weight loss of 0.5-1.0kg per week. o o o o The Food Standards Agency (www.foodstandards.gov.uk) is a reliable source of information and materials. 20 Lifestyle Advice Dietary Advice If appropriate, patients should be advised to: Achieve and maintain a healthy weight Reduce calorie intake if overweight or obese Eat at least five portions of fruit and vegetables each day Reduce dietary intake of fat, especially saturated fat, favouring monosaturates and polyunsaturated fats instead. Increase intake of fibre, especially soluble fibre Reduce dietary salt intake When drinking alcohol, do so in moderation [<14 unit per week for women and <21 units per week for men (where 1unit = glass of wine or half pint of beer)] excess alcohol can cause weight gain and high blood pressure. Do not ‘binge’ drink. Smoking Advice All people with diabetes should be advised of the adverse effects of smoking and, where offered advice on how to stop smoking and where to access appropriate support to enable them to stop (e.g. Local specialized smoking cessation services – New Leaf Services). Exercise The amount of physical exercise an individual should do, will depend upon their individual circumstances. Exercise can include daily or weekly tasks such as gardening, walking to the shops or housework. The overall long-term aim is to do 30 minutes of exercise five times a week. Patients should start doing 5 or 10 minutes per day and gradually build this up. Physical exercise should be sufficient to make patients feel warm and slightly out of breath. They should not be red in the face or ‘out of breath’. Patients should be warned that exercising should only be undertaken following the guidance of a trained healthcare professional, exercise advisor or health trainer. 21 22 Useful Resources Diabetes UK (formerly British Diabetic BBC Health Website Association) Website: http://www.diabetes.org.uk/ www.bbc.co.uk/health 10 Parkway, London NW1 7AA Tel: 020 7424 1000 Fax: 020 7424 1001 Email: [email protected] Careline: 020 7424 1030 (Mon-Fri 9am - Information and background on healthy living and diabetes 5pm) The leading charity working for people with diabetes, funding research, campaigning and helping people live with the condition. Department of Health: Diabetes NSF www.dh.gov.uk/PolicyAndGuidance/HealthAnd SocialCareTopics/Diabetes/fs/en Diabetes Exercise Association (DESA) and Sports Website: www.diabetes-exercise.org/ DESA ‘exists to enhance the quality of life for people with diabetes through exercise and physical fitness’ British Heart Foundation 14 Fitzhardinge Street London Website: http://www.bda.uk.com/ W1H 6DH Tel No: 020 7935 0185 Association aims to inform, protect, Website: www.bhf.org.uk represent and support its members (professionals). British Dietetic Association Food Standards Agency Website: www.food.gov.uk British Hypertension Society Website: www.bhsoc.org The Food Standards Agency is an independent Government department set up by an Act of Parliament in 2000 to protect the public's health and consumer interests in relation to food 23 Supplier Details Omron Omron Healthcare UK Ltd Opal Drive Fox Milne Milton Keynes, UK 15 0DG Tel: 01908 258285 Contact name: Derek Blake, Sales Manager Seca Seca House, 40 Barn Street Digbeth, Birmingham West Midlands B5 5QB Tel: 0121 643 9349 Contact name: Jock Planck, Sales Manager Unichem Professional Services Cox Lane Chessington Surrey KT9 1SN Tel : 020 3044 8434 Contact names : Richard Balcon or Meera Sharma 24 Process Documentation 1. Patient Information Leaflet 2. Patient Consent Form 3. Patient Recruitment Form 4. GP Referral Form 5. Patient Follow-up Form 25 Weight Management Service Patient Information leaflet You are being invited to take part in a weight management service within your local pharmacy. Before you decide to take part, it is important for you to understand the purpose of the service and what it will involve. Please take the time to read the following information carefully and discuss it with relatives, friends and your GP if you wish. Ask the pharmacy staff member if there is anything that is not clear, or if you would like more information. Only patients who are overweight and wish to lose weight will be invited to participate. What is the purpose of the service? For community pharmacists and their staff to identify and support patients within a weight management service in their pharmacy. Who is running the service? - Your local pharmacy Your local Primary Care Trust – NHS Nottingham City UniChem professional Services, an organisation which provides pharmacy training and services. All local GPs have been made aware of this service. What does it mean to be obese or overweight? Living a healthy lifestyle is an important part of our daily lives and an important part of this is maintaining a healthy weight. As well as the obvious psychological effects, such as low self-esteem and stress, being overweight or obese severely increases our risk of serious long-term illnesses such as: Heart Disease Diabetes High Blood Pressure High Cholesterol However, losing weight healthily and maintaining a healthy or ‘ideal’ weight can have dramatic effects. Just a 10% reduction in our weight can help us: Reduce the risk of such illnesses Feel fitter Be more active and do more without getting as tired Feel confident and happier with the way we look We become overweight largely because the calorie intake in our diet is more than the amount of calories our body burns-up. What we eat, how we exercise and our overall lifestyle are important factors in explaining the increase in people overweight and obesity. 26 What will happen to me if I take part? The pharmacy team will need you to attend a set number of appointments. Each appointment will involve an assessment of your diet, exercise and other lifestyle factors. The pharmacy team member will help you to facilitate an action plan based on your individual lifestyle and requirements. You may also be referred to your GP for further advice and treatment if necessary. What are the benefits of taking part? Prevention or early diagnosis of any long-term conditions, therefore, reducing your chances of developing further complications as mentioned above. Do I have to take part? It is your decision whether or not to take part. If you DO decide to take part you should keep this Information Leaflet and you will be asked to sign a Consent Form (you will be able to keep a copy of this). You are free to withdraw from the service at any time, and without giving any reason. This will not affect your current care or any future care that you receive. What happens when the service ends? The pharmacist will continue to be available to answer any questions you may have and give you any advice and support that you may need. Confidentiality – who will know that I am taking part in the service? Your pharmacist is registered under the Data Protection Act 1998. If you decide to take part, no information that can identify you, such as name and address, will be made available to anyone other than your GP. Therefore, any information about you which leaves the pharmacy for data collection purposes will not carry your name and address. If you have any further questions or would like anymore information, please ask your pharmacist. Thank you for taking the time to read this leaflet. Pharmacy stamp 27 Community Pharmacy Weight Management Service Patient Consent Form – Confidential Patient ID code: Please initial box I confirm that I have read and understood the Patient Information Leaflet for the above service and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw from the service at any time, without giving any reason, and without my medical care or my legal rights being affected. If required, I agree to the Pharmacist contacting my GP about my health and/or my medication I agree to take part in the service Name of Patient Date Signature Date Signature (in block capitals) Name of Pharmacist (in block capitals) 28 Weight Management Service PHARMACY DETAILS: Service Evaluation Form IN ORDER TO HELP US PROVIDE YOU WITH ACCURATE, USEFUL ADVICE AND SUPPORT IN MANAGING YOUR WEIGHT AND LEADING A HEALTHIER LIFESTYLE, PLEASE COMPLETE SECTION A OF THIS FORM AS FULLY AS POSSIBLE. ONCE YOU HAVE DONE THIS, ARRANGE A CONVENIENT TIME TO SEE THE PHARMACIST WHO WILL REVIEW THE INFORMATION AND DISCUSS THE NEXT STEP WITH YOU. The information you provide will be strictly confidential. Section A Personal Details Title: First Name: Surname: Date of Birth: Address: GP Name: GP Address: Patient ID Number: (PMR No.) MEDICAL HISTORY Do you suffer from any medical conditions? (If yes, please state) Yes No Please list any regular medication that you take? (Include counter and natural medicines) 29 DIETARY PROFILE Please describe your typical daily dietary intake: Breakfast: Midmorning snacks: Lunchtime: Afternoon snacks: Teatime: Supper: Do you eat at regular times of the day? Yes No Your average daily calorie intake: LIFESTYLE PROFILE Are you a smoker? (If yes, state how many per day) Yes How many per day? Please indicate your unit alcohol consumption per week: Men: No Women: 0 units 0 units 1-7 units 1-2 units 8-14 units 3-5 units 15-21 units 6-14 units >21 units >14 units Please describe your weekly exercise and activity level: (Including work) 30 CLIENT PROFILE Why do you want to lose weight? Are you currently on any form of weight loss/control diet? (If yes, please describe) Yes No Have you previously tried to lose/control your weight? (If yes, please describe) Yes No Height: Metres: Feet/Inches: Weight: Kg: Stone/Pounds: Hip measurement: Waist Circumference: Centimetres: Centimetres: BMI: Inches Inches Waist-to-Hip Ratio: Blood Pressure: Section B ACTION PLAN Diet: Exercise: Lifestyle: 31 GP Referral Form Date Pharmacy Name Dear ---------------------, We have carried out a weight associated risk assessment for your patient below. In line with agreed protocol, it is now appropriate for the patient to be referred to you for the reason(s) specified below: Patient Name…………………………………………………………………………………………………………. Date of birth……………………………………………Date patient was seen……………………... Concerns identified Undesirable side-effects Compliance problem Suspected drug interaction Specialist lifestyle advice required (eg: Health trainer / New Leaf etc.) Patient has failed to achieve significant weight loss over a 3-month period despite diet, exercise and lifestyle interventions, and should be considered for alternative weight loss regime or pharmacotherapy in line with NICE Guidance. Other (please specify) Monitoring Parameters Measurement Weight Result …………….kg Height …………….m BMI …………………….kg/m2 Waist Circumference ….………….cm Hip Measurement ………….…cm Waist-to-Hip ratio …………….. Blood Pressure …….……….mmHg Date Advice and support provided in the pharmacy Monitoring of Blood Pressure/Weight Support with managing their medication Reinforcement of lifestyle advice Smoking Cessation Other (please specify) Additional Notes Many thanks, Pharmacist GREEN COPY = UniChem Professional Services Copy YELLOW COPY = GP/Healthcare Professional Copy WHITE COPY = Pharmacy Copy Pharmacy stamp/details 32 FOLLOW-UP VISIT FORM Follow-up Visit No. (1-10) Pharmacy ID No. Patient ID No. Age Sex Ethnicity Has the patient followed any exercise programme advised at the initial review? Note: Tick the relevant box for type of exercise and amount of exercise taken PER-DAY Has the patient made any lifestyle changes advised at the initial review? White Black Mixed Race Asian Other Walking Swimming Cycling Gym Other NONE NONE NONE NONE 20 min 20 min 20 min 20 min 40 min 40 min 40 min 40 min 1 hr 1 hr 1 hr 1 hr +1 hr +1 hr +1 hr +1 hr NONE Dietary (specify) 20 min 40 min 1 hr +1 hr Please Specify type of exercise and amount taken PER-DAY (tick) Alcohol intake (specify) (tick) Smoking (specify) (tick) Physical Activity/Other (specify) (tick) Weight (kg) Height (m) BMI (kg / m2) Waist (cm) Hip Measurement (cm) Waist-to-Hip ratio Monitoring Parameter Values (if applicable for visit no.) Blood Pressure (mmHg) Pulse 33