Wk 18 Introduction to Public Health-1.pdf

WEEK 18 Introduction to Public Health Susan Gault Dale 121 [email protected] 1 PHA113 MPharm WEEK 18 Learning Outcomes • Understand what we mean by public health • Know how public health fits in with the pharmacy contract • Understand the role of the pharmacist in lifestyle int...

WEEK 18 Introduction to Public Health Susan Gault Dale 121 [email protected] 1 PHA113 MPharm WEEK 18 Learning Outcomes • Understand what we mean by public health • Know how public health fits in with the pharmacy contract • Understand the role of the pharmacist in lifestyle interventions • Be able to make lifestyle interventions for patients who: • Are at risk of high blood pressure • Are overweight • Are smokers 2 PHA113 MPharm WEEK 18 What is Public Health? The science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society.” - The Faculty of Public Health 3 PHA113 MPharm WEEK 18 4 Funding Arrangements for Public Health PHA113 MPharm WEEK 18 What are Community Health Services? • Local Authorities • Charities • GP practices • Community Pharmacies • Sexual Health Clinics • Secondary care trusts (hospitals) • Social Enterprises • Private healthcare providers 5 PHA113 MPharm WEEK 18 6 The Three Domains of Public Health PHA113 MPharm WEEK 18 7 What is pharmacy’s role in PH? - Community Pharmacy Contract PHA113 MPharm WEEK 18 Public Health in the Community Pharmacy Contract • Public Health: Health Promotion • Opportunistic one to one advice given on healthy lifestyle topics to certain patient groups who present prescriptions for dispensing e.g. diabetics, smokers, CHD • May be asked to be involved in up to six local campaigns a year, organised by Local Health Authorities • National campaigns e.g. Stoptober, Be Clear on Cancer • Leaflets and prompts for staff to give advice • This essential service has been used in some areas as part of the Healthy Living Pharmacy programme 8 PHA113 MPharm WEEK 18 Public Health in the Community Pharmacy Contract • Public Health: Health Protection • Disposal of unwanted medicines • Pharmacovigilence • Clinical Governance • • • • • • • 9 Patient and public involvement Clinical audits Risk management Clinical effectiveness Information Governance Education and training Staff management PHA113 MPharm WEEK 18 Public Health in the Community Pharmacy Contract • Commissioned by NHS England on behalf of Public Health England • E.g. influenza vaccinations, hypertension case finding service • Commissioned by Local Authorities • E.g. sexual health, harm reduction, cardiovascular screening, smoking cessation, weight management 10 PHA113 MPharm WEEK 18 Healthy Living Pharmacies • Initially trialled in Portsmouth in 2010 • Now rolled out nationally and incentivised through Pharmacy Quality Scheme • Part of the essential service since 2020/21 • Aim: To highlight and support public health activities from a community pharmacy environment • Utilises a range of services and pharmacy staff to support healthy living • Was acknowledged in the Healthy Lives, Healthy People government paper • Mixed results in the research, but generally seems to increase the number of public health interventions delivered 11 PHA113 MPharm WEEK 18 What does this mean in practice? 12 PHA113 MPharm WEEK 18 13 Behavioural Change Cycle PHA113 MPharm WEEK 18 14 High Blood Pressure PHA113 MPharm WEEK 18 15 Health Burden of High Blood Pressure PHA113 MPharm WEEK 18 Health Burden of High Blood Pressure • There is robust evidence that action to lower blood pressure does reduce the risk to health. • Every 10mmHg reduction in BP resulted in a: • • • • 17% reduction for coronary heart disease 27% reduction for stroke 28% reduction for heart failure significant 13% reduction in all-cause mortality • For every 10 people in England diagnosed with high blood pressure a further 7 people remain undiagnosed and untreated. 16 PHA113 MPharm WEEK 18 17 Risk Factors for High Blood Pressure PHA113 MPharm WEEK 18 Non-modifiable risk factors 1. Age: BP tends to rise with age 2. Ethnicity: people from Black African and Black Caribbean ethnic groups have a higher risk of hypertension than the general population 3. Genetics: Genetic factors play some role in high blood pressure, heart disease, and other related conditions. 4. Gender: up to about 65 years of age, women tend to have a lower BP than men. Between 65–74 years women tend to have a higher BP. 18 PHA113 MPharm WEEK 18 Modifiable risk factors 1. Excessive dietary salt: one of the most important modifiable risk factors for hypertension 2. Obesity: Obese men are more than twice as likely to develop hypertension and obese women 3 times more likely. 3. Excess alcohol consumption: Heavy habitual consumption of alcohol links to raised BP. 19 PHA113 MPharm WEEK 18 Modifiable risk factors 4. Lack of physical activity: People who do not take enough aerobic exercise are more likely to have or to develop hypertension. 5. Impact of deprivation and socioeconomic status: The burden of hypertension is higher in individuals from poorer socioeconomic backgrounds. 6. Mental health: Anxiety and stress can increase hormones like adrenaline and cortisol which impact blood pressure and heart rate. 20 PHA113 MPharm WEEK 18 High Blood Pressure: How high is too high? • NICE guidelines state: • Stage 1 hypertension • Clinic BP between 140/90 mmHg - 159/99mmHg • Stage 2 hypertension • Clinic between 160/100 mmHg - 180/120 mmHg • Stage 3 or severe hypertension • Clinic systolic blood pressure of 180 mmHg or higher or • Clinic diastolic blood pressure of 120 mmHg or higher. 21 PHA113 MPharm WEEK 18 Next steps after taking a BP reading • Patients with hypertension must be referred to GP • Borderline patients should have consultation and offered re-test at later date • All patients should be offered lifestyle advice 22 PHA113 MPharm WEEK 18 Lifestyle Advice for People with High BP • Consider the modifiable risk factors • What does the patient already do • What do they need to stop/start doing 23 PHA113 MPharm WEEK 18 Lifestyle Advice for People with High BP • Dietary sodium • Encourage people to keep their dietary sodium intake low, by reducing or substituting sodium salt, as this can reduce blood pressure. • Be aware that salt substitutes containing potassium chloride should not be used by older people, people with diabetes, pregnant women, people with kidney disease, and people taking some antihypertensive drugs (such as angiotensin-converting enzyme inhibitors and angiotensin-II receptor blockers). • Diet and exercise • Explain that a healthy diet and regular exercise can reduce blood pressure. • If the person is overweight or obese, offer weight loss advice. • For more information, see the CKS topic on Obesity. 24 PHA113 MPharm WEEK 18 Lifestyle Advice for People with High BP • Alcohol • If the person drinks excessively, encourage a reduced intake because this can reduce blood pressure and has broader health benefits. • For more information, see the CKS topic on Alcohol problem drinking. • Caffeine • Discourage excessive consumption of coffee and other caffeine-rich products. • Smoking • Offer advice and help to smokers to stop smoking. • For more information, see the CKS topic on Smoking cessation. 25 PHA113 MPharm WEEK 18 Resources • Scenario: Management | Management | Obesity | CKS | NICE • Scenario: Management | Management | Hypertension | CKS | NICE • How to screen | Diagnosis | Alcohol - problem drinking | CKS | NICE • Scenario: Adults | Management | Smoking cessation | CKS | NICE • The Eatwell Guide - NHS (www.nhs.uk) 26 PHA113 MPharm