Introduction

Several localised health issues pertaining to the area of chronic diseases were identified, including: poor access to GP services; high myocardial infarction rates; overweight and obesity; nutrition; healthy eating; high levels of chronic disease; areas of deprivation; and the impact of the social determinants of health within the County. The evidence gathered throughout the research and consultation process identified that a chronic disease risk management programme in a community pharmacy setting would be beneficial to the population of County Meath.

Objective

The aim of the programme is to improve healthy lifestyle behaviours associated with the risk of developing a chronic disease. The purpose of the programme is to:

• Raise awareness of risk factors for chronic disease among the citizens of County Meath
• Educate the citizens of County Meath on how to reduce those factors and provide them with tools to achieve this
• Elicit behaviour change through referral, personalised lifestyle advice, and follow up
• Gather local data to identify trends and health needs in this area
• Achieve the project outcomes for The Healthy Ireland Fund 2023-2025 Local Strategy for Meath County Council

Solution

Since September 2023, Healthy Meath, in collaboration with the Irish Pharmacy Union, Community Pharmacies, and Roche Diagnostics has been delivering a chronic disease risk management programme in local pharmacies within County Meath.

The programme is delivered by the Pharmacist and includes six steps:

The purpose of this questionnaire is to identify individual risk behaviours. The questions posed to individuals relate to eating habits, alcohol consumption, exercise habits, and any other medication (including over-the-counter remedies) they might be taking.

Tests

The tests conducted facilitate the risk assessment of the individuals. Some of the tests involve the collection of blood samples from the individual. The tests provided are:

• Waist circumference
• Blood pressure
• Pulse rate
• Lipid profile (cholesterol)
• Glycated haemoglobin (HB1Ac)

Advice and Referral

Based on the results obtained, the Pharmacist will:

• Refer the individual to a healthcare professional and/or
• Provide relevant lifestyle advice and support material in accordance with the SOP relating to the point of care provided

Follow up

Each participant is followed up 4 weeks after their initial health check to assess the impact of the health check on the individual’s behaviour.

Implementation

The programme is currently running in nine community pharmacies across the County which were recruited via the Irish Pharmacy Union (IPU). Each pharmacy received protocols and guidance from the IPU to ensure standardisation of service delivery across all community pharmacy locations. Roche Diagnostics provide medical devices and consumables to pharmacies as required, which facilitates the delivery of glycated haemoglobin (HbA1c) and lipid profile point of care testing in all locations. Roche also provides the relevant training for using the equipment, quality control, and interpreting the results. Healthy Meath provides oversight to the partners, funding, and supports the service with advertising, promotion, and individual engagement. All participants provide written consent to the pharmacist to avail of the programme and for anonymized data collected and health check results, as part of the service to be shared in a report.

Results

Although the project is ongoing, Healthy Meath analysed the initial findings from the first three pharmacies who participated in this initiative.

The results of the health check demonstrated that:

• 60 participants aged between 40 and 65 received a free health check in the initial phase, 68% of whom were female
• 93% of participants have a family history of cardiovascular diseases, including diabetes
• 27% of participants were smokers
• 64% of participants consumed alcohol
• 56% consumed less than the recommended 5 to 7 portions a day of fruit and vegetables
• 43% of participants did not consume any oily fish weekly
• 46% of participants did not have optimal or normal blood pressure values
• 80% of participants had a waist circumference measurement above the healthy parameter

Four weeks after the health check, participants were contacted to assess the impact of the interaction. The following is an overview of the observations made.

• 97% of participants had improved their awareness of risk factors linked to chronic disease
• 81% of those participants who received dietary advice had made a change to their diet
• 67% of those participants who received physical activity advice have made a change to their physical activity
• 33% of those participants who received smoking advice reported that they had quit or sought help to quit smoking
• 36% of those participants who received advice on alcohol consumption reported that they had reduced their alcohol intake
• 75% of those participants who were referred to their GP, visited their GP
• One individual was diagnosed by their GP with a health issue related to their health check results

Benefits

This project demonstrates that through collaboration, it is feasible to provide a free and accessible health check service in a community pharmacy setting, that targets the social determinants of health and removes barriers for individuals who may experience constraints when trying to attend their GP. It builds the evidence base, as outlined in the recent IHF report, that “upstream” policy-based CVD prevention strategies are more effective, equitable, and cost-efficient than ‘downstream’ preventive activities targeting individuals. This programme has and will continue to support individuals to have greater awareness of the risk factors for chronic diseases, which are the leading cause of death in Ireland. It will empower individuals to take control over their own health and provide them with the education and resources to lead a healthier lifestyle.

Challenges and Lessons Learned

Several challenges were encountered, including:

• Participant engagement: raising awareness and getting community members to participate is challenging at times. This requires ongoing promotion by Healthy Meath, the Pharmacies, the IPU as well as through word of mouth among the participants
• Data quality: ensuring the data collected is accurate. The IPU oversees this as they have expertise in the area and are liaising with the pharmacies on any issues, they have
• Resource constraints: limited funding, manpower, and time can hinder the project at times. Building the evidence base for the project’s impact, organisation by the pharmacists, and ongoing support have alleviated this

Addressing these challenges with careful planning and community involvement has led to a successful health check project.

Conclusion

Community pharmacies are appropriate healthcare settings, widely accessible across Ireland, for the provision of health checks. Therefore, the implementation of similar programmes across the country would be beneficial to members of the public. The results of this programme demonstrate that having an ‘upstream’ policy in place based on cardiovascular diseases will be more effective, equitable, and cost-efficient than a ‘downstream’ policy. Prevention is the key to achieving better healthcare outcomes.

For more information on this programme please visit the Healthy Meath webpage or email [email protected]

Testimonials from those that took part.

‘’Exciting to take part in this chronic disease risk management programme which meant we use our full potential and knowledge to improve health in the population and identify people at risk’’ . Pharmacist who participated in the initiative:

“I’d like to see the program being rolled out nationwide. It would likely same many lives if it were”.Participants who participated in the initiative:

“Great initiative to have available and the service was excellent’’.Participants who participated in the initiative: