An evaluation of NHS Health Checks in community pharmacy;
changes in cardiovascular risk factors over one year in patients aged 40-74
SJ Butterworth
SC Willis
P Higginson
Manchester Pharmacy School
The University of Manchester
NHS Health Check
• Cardiovascular risk assessment
• Provided in the English National Health Service
• Population aged 40-74 without recognised cardiovascular disease– Assess cardiovascular risk factors
– Calculate cardiovascular risk (QRisk2-12)
– Convey risk to user in a way they can understand
– Provide supporting lifestyle advice
• Evaluate the implementation of NHS Health Checks in a community pharmacy by comparing against national standards and targets
• Investigate the outcomes of intervention by reassessing a sample of patients after a period of around one year.
Study design
• Single community pharmacy in a rural setting in England
• Initial Health Checks on eligible population (from December 2012-June 2014)
• Follow up after about 1 year on a subset of that population (invited sequentially to return up to a minimum of 50)
Can community pharmacy in non-urban settings effectively contribute to targets for the proportion of Health Checks completed?
England Cumbria LSOA 007
Number Eligible 15,308,022 167,367 586
Number Offered 2,824,426 (18.5%)
40,142 (24.0%) N/A
Number Received 1,382,864 (9.0%) 18,276 (10.9%) 139 (23.7%)
What are the outcomes of health checks completed in community pharmacy either through measurable changes over 12 months or through referral?
Initial cohort results
• 161 participants, mean age 57.5 (95% CI 56.0-58.7)– 98 female (60.9%) mean age 57.3 (CI 55.6-59.0)
– 63 male (39.1%) mean age 57.5 (CI 55.2-59.7)
• Mean 10 year CVD Risk 9.3% (CI 8.2-10.5)– Male CVD Risk 12.9%
– Female CVD Risk 7.1%
• P=0.0003
Initial cohort referral
• 161 participants– 78 referred (48.4%)
• 59 had BP > 140/90mmHg
• 7 had raised total cholesterol >7mmol/l
• 23 had BMI > 30
• 18 had Qrisk > 20
Follow up cohort
Wilcoxson’s Signed Rank Test
QRisk2 Mean 95% CI Median Difference Two Sided P
Approx 95% CI
All T1% 7.8 6.3-9.3 7 0.002 -1 to -0.5
All T2% 8.6 7.0-10.2 8
Fem T1% 5.6 4.2-7.0 4.5 0.1134 -1 to 0
Fem T2% 6.0 4.5-7.5 5
Male T1% 11.0 8.4-13.6 10 0.0095 -2 to -0.5
Male T2% 11.8 9.2-14.4 12
52 participants received repeat Health Check (at around 1 year)
Cardiovascular risk profile vs health Strategy
Ref: World Health Organisation. Prevention of Cardiovascular Disease. 2007
Conclusion
• Community pharmacy is able to identify and refer high cardiovascular risk patients
• Community pharmacy can contribute to targets for delivery of NHS Health Checks
• The extent to which community pharmacy can contribute to longer term outcomes through NHS Health Checks is unknown
Acknowledgement
• Grateful thanks to the Health Education Foundation, whose educational bursary supported this study