OSPAP Programme Screening in Pharmacy PDF

WEEK 11 OSPAP Programme Screening in the pharmacy Rebecca Waton [email protected] Slide 1 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Screening...

WEEK 11 OSPAP Programme Screening in the pharmacy Rebecca Waton [email protected] Slide 1 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Screening “The systematic application of a test process to people who have not previously sought medical attention for a disorder, to identify individuals at sufficient risk of the disorder to warrant further investigation” Slide 2 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Can you think of any examples of screening? Blood testing Physiological testing Microbiology testing Questionnaire Combination of these to form a more comprehensive risk assessment Can be population based, selective, opportunistic Slide 3 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Aims of Screening Save lives Improve quality of life through early diagnosis of serious conditions Reduce risk of developing condition Reduce complications of existing conditions Requires careful assessment of risks and benefits Slide 4 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Population Based Screening According to WHO (Strong, Wald and Miller, 2005) only if: – Disease is significant health problem – Natural history of the disease is understood – There is an identifiable preclinical stage of the disease – Tests are reliable – Benefits of treatment after early detection are better than those if treatment is delayed – Process is cost-effective – Screening will be a systematic ongoing process Slide 5 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 OSPAP Programme What screening opportunities do you think exist in community pharmacy? Slide 6 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 What screening opportunities do you think exist in community pharmacy? Selective screening – Chlamydia with EHC consultations Opportunistic – Asthma Control Test (ACT) when collecting inhalers In collaboration with primary care – Blood pressure As part of a public health campaign – AUDIT-C for alcohol awareness campaign Responding to symptoms – “Red flags” e.g. weight loss with constipation Slide 7 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Chlamydia Screening In 2021 focus changed to reducing reproductive harm of untreated infection in young women and other people with a womb or ovaries. Most commonly diagnosed STI in the UK increased 24.3% from 160,279 diagnoses in 2021 to 199,233 in 2022, 194,244 in 2023 Affects both men and women Usually asymptomatic Highest prevalence in people under 25 Rates of chlamydia diagnoses by gender and age: England, 2022 Testing of urine sample or vaginal swab Easily treated with antibiotics Highest 'at risk' ethnicity is black ‘Other’ (non-African or Caribbean) ethnicity and black Caribbean ethnicity Slide 8 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Chlamydia Screening In 2023, pharmacy made up 0.3% of the NHS chlamydia screening program a decrease of 34.7% from 2022 (42.7% ordered online) Clamelle is a private screening and treatment programme available through pharmacies Patients presenting for EHC may have had unprotected sex, so offering screening alongside EHC can be a targetting tool Northumberland Sexual Health Level 2 service incorporates chlamydia screening Now includes Slide 9 of 23 Gonorrhoea MPHM15 OSPAP Screening in Pharmacies  Gonorrhoea In 2022 there were large increases in the cases of Gonorrhoea + 50.3% from 54,961 in 2021 to 79,268 in 2022, further increase to 85,226 in 2023 Largest annual number reported since records began Similarly, syphilis has highest recorded numbers since 1948. Again increased 9.4% from 2022 to 2023 Slide 10 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Asthma Control Test In 2020 a survey by Asthma & Lung UK showed 24% of respondents had uncontrolled asthma Proportionally meaning 1.3 million people are at risk of a life-threatening asthma attack A score under ≤ 20 shows poorly controlled asthma Slide 11 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 NHS Health Checks (2009) Patients aged between 40-74 years old every 5 years and without prior diagnosis Combination of tests to establish risk of CVD, Stroke, T2DM, renal disease – Questionnaire – BP – Cholesterol level – BMI QRISK-3 to be used for CVD, if data is not accessible only QRISK-2 fields can be filled Where higher risk, it should be communicated with the patient and interventions can then be planned Slide 12 of 23 MPHM15 OSPAP Screening in Pharmacies Slide 13 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 NHS Health Checks (2009) It is estimated that the programme could prevent - 1,600 heart attacks and strokes - 650 premature deaths - 4,000 new cases of diabetes each year It could also lead to at least 20,000 cases of diabetes or kidney disease being detected earlier Community pharmacies were commissioned to provide NHS health checks Public Health England pledged to engage community pharmacy more to increase the uptake of NHS Health Checks now under Office for Health improvement and disparities (OHID) from October 2021 Move to make more use of digital technology without creating any exclusion to certain patient groups Slide 14 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Evaluation of NHS Health Checks Strong et al. (2016) conducted an evaluation of the first 4 years of NHS Health Checks Used data from one of the general practice clinical systems (n=655 practices) Good uptake in areas of high social deprivation (14.9% eligible patients) Increasing uptake from 2009/10 (5.8%) to 2012/13 (30.1%) – 38/1000 checks identified new hypertension – 9/1000 checks identified new diabetes – 4/1000 identified new chronic kidney disease Of those identified at higher CVD risk (>20%) – 19.3% were started on a statin – 8.8% started on a new antihypertensive therapy Slide 15 of 23 MPHM15 OSPAP Screening in Pharmacies  QRISK Risk calculators can be found at: https://www.qrisk.org/ Uses several parameters to work out a patient’s cardiovascular risk over the next 10 years QRISK 2 or 3 available – QRISK3 is recommended by NICE Updated annually Slide 16 of 23 MPHM15 OSPAP Screening in Pharmacies  QRISK 3 Slide 17 of 23 MPHM15 OSPAP Screening in Pharmacies  Hypertension case finding service 2021 To find undiagnosed cardiovascular disease in the over 40s If blood pressure is elevated (140/90mmHg or higher, but lower than 180/120mmHg) Ambulatory monitoring is offered A follow up appointment is arranged, and equipment returned Patient is referred to their GP for treatment Further information can be found at: https://cpe.org.uk/national-pharmacy-services/advanced-services/hypertension- case-finding-service/ Slide 18 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 AUDIT-C (NICE, 2010) Alcohol Use Disorders Identification Test – Consumption Scori ng system You r Qu est ion s 0 1 2 3 4 score 2 -4 2 -3 4+ Monthly times times times How often do you have a drink containing alcohol? Never per per per or less month week week How many units of alcohol do you drink on a typical 1 -2 3 -4 5 -6 7 -9 10+ day when you are drinking? How often have you had 6 or more units if female, or Daily or 8 or more if male, on a single occasion in the last Less than almost Never Monthly Weekly year? monthly daily A score of 5+ indicates increasing or higher risk drinking and remaining AUDIT questions can be asked Slide 19 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 AUDIT-C (Davies at al., 2013) Pharmacies have been identified as a place where alcohol screening could be delivered from ‘Scratchcards’ have been developed as part of screening programmes through pharmacies as public health campaigns (essential service) Slide 20 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 AUDIT-C (Davies et al., 2013) Slide 21 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 Further Information www.screening.nhs.uk https://cpe.org.uk/ Krska, J. (ed.) (2011) Pharmacy in Public Health. Pharmaceutical Press, London www.asthma.org.uk www.alcohollearningcentre.org.uk Slide 22 of 23 MPHM15 OSPAP Screening in Pharmacies WEEK 11 References Davies, J. et al. (2013) Pan-London Pharmacy Alcohol Awareness Campaign Available at: http://www.pharmacylondon.org/wp- content/uploads/2012/12/Alcohol-Final.pdf (Accessed 07 October 2014) Nathan R.A. et al. (2004) ‘Development of the asthma control test: A survey for assessing asthma control’, J Allergy Clin Immunol, 113, pp. 59-65. National Institute for Health and Clinical Excellence (NICE) (2010) Alcohol use disorders: Preventing harmful drinking. Available at: http://www.nice.org.uk/guidance/PH24 (Accessed: 07 October 2014) National Institute for Health and Clinical Excellence (NICE) (2012) Preventing type 2 diabetes: risk identification and interventions for individuals at high risk NICE: London Available at: https://www.nice.org.uk/guidance/ph38 (Accessed 01 October 2015) Office for Health Improvement & Disparities (2022) Guidance NHS Health Checks: applying All Our Health Available at: NHS Health Checks: applying All Our Health - GOV.UK (www.gov.uk) (Accessed 27th September 2024) Pharmacy Magazine (May 2022) Management of uncontrolled asthma in community pharmacy Available at: https://www.pharmacymagazine.co.uk/clinical/management-of-uncontrolled-asthma-in-community-pharmacy (Accessed 15th September 2023) Public Health England (2019) NHS Health Check Best Practice Guidance For commisioners and providers Available at: file:///C:/Users/ue0lmr/Downloads/20200417%20NHS%20Health%20Check%20Best%20Practice%20Guidance%202019 _update.pdf (Accessed 15th September 2023) Strong, K, Robson J, Dostal I, Sheikh A, et al. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open 2016;6: e008840. UK Health Security Agency (2023) Sexually transmitted infections and screening for chlamydia in England: 2023 Report Available at: Sexually transmitted infections and screening for chlamydia in England: 2023 report - GOV.UK (www.gov.uk) (Accessed 27th September 2024) Wald, N. and Miler, A. (2005) ‘Current concepts in screening for noncommunicable disease: World Health Organization Consultation Group Report on methodology of noncommunicable disease screening’, J Med Screen, 12(1), pp. 12-19. Slide 23 of 23 MPHM15 OSPAP Screening in Pharmacies