Download Benefits of 10kg (10%) weight loss in a 100kg subject

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:






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


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