June Blog: Blood Pressure and Atrial Fibrillation Screening
Blood Pressure/Atrial Fibrillation Screening
High blood pressure increases the likelihood of premature death and disability. It is associated with at least half of all heart attacks and is a major risk factor for chronic kidney disease, heart failure and cognitive decline. The cost to the NHS is thought to be around £2bn and there are associated costs for social care and reduced productivity.
For every ten people diagnosed with high blood pressure it is estimated that seven remain undiagnosed and therefore untreated. With this in mind the NHS England and North Midlands (Derbyshire and Nottinghamshire) team commissioned a Community Pharmacy Blood pressure (BP) and Atrial Fibrillation (AF) Drop-in service in February this year. The aim of the service was to see if community pharmacy could play a part in early detection. It was also thought that opportunistic advice could be offered to reduce risk factors for Cardiovascular Disease (CVD).
How are we getting on? The nine-month long project started on 1 February 2019 and by mid-May there had been 1,053 provisions of service from 76 active providers (out of 93 accredited to deliver the service). The engagement with the service has been variable and the Top five contractors have done 36% of the screens. However, the project is already yielding some interesting results and helping to build the evidence base for community pharmacy screening in this area:
- Low blood pressure (refer) 0.9% (systolic reading below 90mmHg)
- Normal blood pressure 62.5% (91/61mmHg to 139/89mmHg)
- High blood pressure (refer) 30.8% (140/90mmHg to 179mmHg)
- Very high blood pressure (urgent referral) 2.3% (180/110mmHg and above)
- Atrial fibrillation indicated 2.3% (1 in 43)
The figures appear to be in line with the expected prevalence for England for both BP (24%) and AF (2.5%). Whatever the outcome the implications of their results are explained to the client. Referrals are made as per the agreed protocol and the opportunity is taken to provide lifestyle advice on how to maintain a healthy blood pressure (i.e. diet, alcohol, weight management, exercise and smoking cessation).
Derbyshire LPC is very supportive of the project and encourages accredited providers to actively engage with delivering as many screens as possible. We intend to contact high activity contractors to identify best practice that can be shared with others to reduce barriers and increase activity. Our preliminary thoughts are that motivated and engaged individuals make a big difference as does involving the whole team in promoting the service. It is also thought that different contractor groups face different barriers to engagement and we will be exploring how best to support our CCA, AIMp and Independent contractors.
The service is primarily walk-in so the uptake can be managed to avoid busy times. However, in some pharmacies making appointments has helped or doing the screening as part of delivering another service such as MURs or NMS. Feedback suggests that it can be difficult to manage the time, because patients want to talk about other issues and health concerns. Over running can cause operational difficulties for the team, so we will be looking to give some guidance on how to maintain focus and not get side tracked.
Different geographies will have different populations and the level of interest in health matters/awareness will vary. The location of the pharmacy is probably also a factor and it will be interesting to see the differences between High Street and Health Centre locations. There is also a gender imbalance as 70% of screens have been done on women and 30% on men. This could have a lot do with our customer base, but men are more commonly affected than women, so how can we engage more with them?
By identifying people who are potentially at-risk community pharmacy can make a big impact on people’s health and wellbeing as treatment significantly reduces the risk of heart attacks, stroke, heart failure and mortality from other causes. For every 10mmHg reduction in systolic BP there is a 20% reduction in major cardiovascular events. It should however be noted that one in three diagnosed with high BP are not treated to target.
Community Pharmacy could make a big contribution in identifying undiagnosed high BP and AF. In addition, we already have a role with supporting diagnosed patients to get the best from their treatment through MURs and NMS. I encourage accredited providers of the Drop-in project to increase their screening activity and make a final push before the end of October to really get behind the service (funding is available for 5,000 screens). This will help to build the evidence base and encourage commissioners to consider developing a comprehensive service that is open to all contractors.
Also, while I have your attention, I would like to point you towards our Health Champions closed Facebook page. We are looking for members so please take a look at the page here https://www.facebook.com/groups/144590669467837/ and send a request to the group.