Community Pharmacy Public Health Campaign 2013

Transcription

1 Community Pharmacy Public Health Campaign 2013 Results and Conclusions Authors Donal Markey, Pharmacy Advisor ( NW London) Christopher Prior, Senior Analytics Lead- Quality (London region) 10/22/2014

2 Contents Introduction... 3 Raising the level of awareness of untreated anxiety and depression in people living with COPD... 4 Overview... 4 Scope of the campaign... 4 Methodology... 4 Pharmacy Activity Questions... 4 Evaluation of results... 5 Results were rejected... 5 Results were adjusted... 5 Stated assumptions... 5 Results... 6 Total Activity... 6 Question 1:... 6 Results... 6 Analysis... 6 Conclusion... 7 Question Results... 8 Analysis... 8 Conclusion... 8 Question 3:... 9 Results... 9 Analysis... 9 Conclusion... 9 Question 4: Results Analysis Conclusion Promoting the Seasonal Flu Immunisation Programme 2012/ Overview Scope Methodology Pharmacy Activity questions

3 Evaluation of results Results were rejected Results were adjusted Stated assumptions Results Total Activity Question 1: Results Analysis Conclusion

4 Introduction This report includes an analysis of 2 community pharmacy public health campaigns from Raising the level of awareness of untreated anxiety and depression in people living with COPD 2. Promotion of the Seasonal Flu immunisation 2012/13 3

5 Raising the level of awareness of untreated anxiety and depression in people living with COPD Overview Anxiety and depression are common in patients with severe COPD and particularly in those who are hypoxic or severely dyspnoeic. Their presence may be overlooked in patients with COPD because of the overlap of many of the symptoms of these conditions and COPD. Pharmacies are an ideal resource to promote the aware of mental health and well-being in patients living with long term conditions such as COPD. The mode of delivery of this campaign is different to other pharmacy public health campaigns in that it is attempting to utilise 3 common sources of information used by individuals when seeking advice on wellbeing; pharmacies, the internet and the NHS. This campaign was designed for people who are willing to use the internet as a health information source. Concurrently it is designed to utilise pharmacies to promote NHS Choices as the website of choice. Scope of the campaign Raising the level of awareness of undiagnosed or untreated anxiety and depression in people living with COPD, the carers of people living with COPD and community pharmacy staff. Methodology There are no supporting leaflets or posters for this campaign; instead pharmacies were requested to target COPD patients and their carers and direct individuals to the NHS Choices website as the primary source of information for mental health and wellbeing; specifically to encourage patients and carers to participate in the Mood zone area of the website. This area contains information and advice about stress, anxiety and depression as well as a number of validated self-assessment tools which can be used to identify anxiety and depression. Mood zone can be accessed by a number of routes through the website; searches using the tools or health A-Z sections within NHS Choices or entering Moodzone into the site search engine will bring the user to the relevant area. The NHS choices website can be accessed by simply putting NHS Choices into a search engine or there is usually a link from any NHS or Public Health England organisations website. Pharmacy Activity Questions 1. Total Number of contacts 2. Total Number of contacts with COPD patients 3. Total Number of contacts who are carers 4

6 4. Total Number of contacts who are COPD patients living on their own Evaluation of results Results were rejected No HWB was identified No borough was identified If more than one differing borough or HWB was identified If an exact figure for contacts was not stated e.g +100 Results from a pharmacy not included in a London borough Results were adjusted A range was stated, the mid-point was recorded e.g , 75 contacts entered Figures were written e.g nine was entered as 9 If one question was not answered data from the other 3 questions was included, this involved < 10 entered therefore it was not statistically significant Stated assumptions No duplication of results (each pharmacy made one entry) Data was collected as a result of a single contact All contacts occurred in a community pharmacy setting All data collection is 100% accurate The campaign ran for the designated timeline 5

7 Results Total Activity Total No Pharmacy Responses 1100 Total Excluded after adjustment 4 Total No pharmacy Responses for analysis 1096 Question 1: Total number of contacts during the campaign? Results London Total contact Average/pharmacy 14 contacts/pharmacy Response Range across London Hammersmith & Fulham Richmond 38 contacts/pharmacy 3 contacts/pharmacy London LAT (average per pharmacy) NE NW SL 13 contacts/pharmacy 13 contacts/pharmacy 16 contacts/pharmacy 95%CI were applied to the data on a borough basis as an assessment of the variation in results 9 Boroughs higher than the London mean 14 boroughs lower than the London mean 10 Borough within 95% CI of London mean Analysis At the time of delivery there were 1844 pharmacies in London therefore the response rate was 60%. Only 4 submissions were rejected and 28 required adjustment. This demonstrates a very high level of adherence to data collection by responding pharmacies. All conclusions in questions 1 to 4 are based upon a 60% rate among pharmacies with a very high level of accuracy in responses. Based upon previous response rates for public health campaigns in pharmacy settings, the methodology 6

8 used for data collection achieved an acceptable response rate and demonstrates a strong potential for future use or 94% of the total number of contacts were either COPD patients or carers, only 1037 or 6% did not fall into either category. Again there was significant variation in interventions. In Hammersmith & Fulham the average number of contacts was 1.7 times the London average whilst City of London average was significantly lower than the London average. 30% or 10 boroughs were not statistically different from the London average of 14 contacts/pharmacy. Conclusion All conclusions in questions 1 to 4 are based upon a 60% rate among pharmacies with a very high level of accuracy in responses. 70% boroughs were statistically different from the London average of 14 contacts /pharmacy. This demonstrates huge variations in results across London therefore a huge variation in pharmacy practice in the delivery of this intervention. Further analysis is recommended to understand reasons for this variance. The campaign demonstrated the ability of community pharmacy to deliver a public health intervention to a cohort of almost people. Further analysis is recommended to quantify any benefit. 7

9 Question 2. Total number of contacts with COPD patients Results London Total contact Average/pharmacy 11 contacts/pharmacy Response Range across London Hammersmith & Fulham Merton 27 contacts/pharmacy 7 contacts/pharmacy London LAT (average per pharmacy) NE NW SL 10 contacts/pharmacy 10 contacts/pharmacy 12 contacts/pharmacy 95%CI were applied to the data on a borough basis as an assessment of the variation in results 8 Boroughs higher than the London mean 13 boroughs lower than the London mean 12 Borough within 95% CI of London mean Analysis 76% of the total number of contacts was COPD patients. Again there was significant variation in the % of COPD patients who received an intervention. In Hammersmith & Fulham the average number of contacts was 2.5 times the London average whilst Merton average was significantly lower than the London average. 36% or 12 boroughs were not statistically different from the London average of 11 contacts/pharmacy. Conclusion 64% boroughs were statistically different from the London average of 11 contacts /pharmacy. This demonstrates huge variations in results across London therefore a huge variation in pharmacy practice in the delivery of this intervention. Further analysis is recommended to understand reasons for this variance. The campaign demonstrated the ability of community pharmacy to deliver a public health intervention to COPD patients. Further analysis is recommended to quantify this benefit. 8

10 Question 3: Total contacts who were carers? Results London Total contact 2814 Average/pharmacy 3 (2.7) contacts/pharmacy Response Range across London Hammersmith & Fulham Richmond 12 contacts/pharmacy 0.3 contacts/pharmacy London LAT (average per pharmacy) NE NW SL 3 (2.6) contacts/pharmacy 2 (2.5) contacts/pharmacy 2 (2.5) contacts/pharmacy 95%CI were applied to the data on a borough basis as an assessment of the variation in results 8 Boroughs higher than the London mean 14 boroughs lower than the London mean 11 Borough within 95% CI of London mean Analysis 18% of the total number of contacts was carers. Again there was significant variation in the % of carers who received an intervention. In Hammersmith & Fulham the average number of contacts was 4 times the London average whilst Richmond average was significantly lower than the London average. 33% or 11 boroughs were not statistically different from the London average of 3 contacts/pharmacy. Conclusion 67% boroughs were statistically different from the London average of 3 contacts /pharmacy. This demonstrates huge variations in results across London therefore a huge variation in pharmacy practice in the delivery of this intervention. Further analysis is recommended to understand reasons for this variance. The campaign demonstrated the ability of community pharmacy to deliver a public health intervention to carers. Further analysis is recommended to quantify this benefit. 9

11 Question 4: Total Number of COPD patients who live on their own Results London Total contact 4756 Average/pharmacy 4 (4.4) contacts/pharmacy Response Range across London Hammersmith & Fulham Harrow 17 contacts/pharmacy 7 contacts/pharmacy London LAT (average per pharmacy) NE NW SL 4 (4.2) contacts/pharmacy 4 (3.9) contacts/pharmacy 5 (4.8) contacts/pharmacy 95%CI were applied to the data on a borough basis as an assessment of the variation in results 8 Boroughs higher than the London mean for contacts/pharmacy 13 boroughs lower than the London mean for contacts/pharmacy 12 Borough within 95% CI of London mean of 4 contacts/pharmacy Analysis There is a correlation between an increased presence of mental health issues and living alone in some COPD patients. 39% or 4 in 10 contacts involved COPD patients living alone. In theory these patients could have a greater benefit from receiving the intervention. Further analysis is recommended to quantify this benefit. Again there was significant variation in the % of patient living alone who received an intervention. In Hammersmith & Fulham 62% of COPD patient were living alone whilst in Harrow 28% of COPD patients were living alone. 36% or 12 boroughs were not statistically different from the London average of 4 contacts/pharmacy. Conclusion 64% boroughs were statistically different from the London average of 4 contacts /pharmacy. This demonstrates huge variations in results across London therefore a huge variation in pharmacy 10

12 practice in the delivery of this intervention. Further analysis is recommended to understand reasons for this variance. The campaign demonstrated the ability of community pharmacy to deliver a public health intervention to a harder to reach cohort of patients who may gain significant benefit. Further analysis is recommended to quantify this benefit. 11

13 Promoting the Seasonal Flu Immunisation Programme 2012/13 Overview Community pharmacies were asked to promote the annual NHS seasonal flu campaign across London. Scope Raising the level of awareness of the benefits of receiving a seasonal flu immunisation to at risk groups of the population of London who use community pharmacies. Encouraging members of at risk groups Methodology The intervention is defined as promoting access to Seasonal Flu vaccination to all at risk groups, and in particular those at risk under 65 and pregnant women. Remind the public of how to deal with and limit the spread of flu-symptoms. This campaign encourages all patients and public to seek advice from their Community Pharmacy. Pharmacies were issued with supporting leaflets or posters for this campaign. All pharmacies staff made opportunistic brief interventions in the pharmacy setting with assumed members of at risk groups. At risk group were identified by FP10 prescription, through the Pharmacy Patient Medication record, my sight. A flu vaccine is available free on the NHS if you: * are pregnant * 65 or older * have certain serious medical conditions * live in a residential or nursing home * carer Pharmacy Activity questions 1. Number of contacts reminded of seasonal flu vaccination and signposting to vaccination provider during campaign? 2. Number of contacts reminded of seasonal flu that are at risk groups during campaign? 3. Number of leaflets distributed / taken during campaign? 4. Flu poster displayed during campaign? 5. Number of people signposted to a flu vaccination provided during campaign? Analysis was performed only on the results for question 1. This was due to resources and capacity. It was also felt that the results of this question would have the most impact and be the best comparator with other pharmacy PH campaigns i.e. COPD. Analysis can be expanded to the remaining 4 questions from question 2 question 5, at a future date in agreement with NHS England 12

14 Evaluation of results Results were rejected No HWB was identified No borough was identified If more than one differing borough or HWB was identified If an exact figure for contacts was not stated e.g +100 Results from a pharmacy not included in a London borough Results were adjusted A range was stated, the mid-point was recorded e.g , 75 contacts entered Figures were written e.g. nine was entered as 9 Stated assumptions No duplication of results (each pharmacy made one entry) Data was collected as a result of a single contact All contacts occurred in a community pharmacy setting All data collection is 100% accurate The campaign ran for the designated timeline Regarding duplication a previous analysis estimated there were potentially 99 duplicate entries (6% of entries). It is not possible to establish if these duplicate entries were made up of solely new data or a mixture of original and new data. A sub-analysis of a cross section of these duplicate entries reveals that only 10% show a duplication of number entries and 10% were rejected as part of the overall evaluation process applied. Therefore the assumption has been made that there are no duplicate entries and all entries are original data. Results Total Activity Total No Pharmacy Responses 1538 Total Excluded after adjustment 66 Total No pharmacy Responses for analysis 1472 Question 1: Number of contacts reminded of seasonal flu vaccination and signposting to vaccination provider during campaign? 13

15 Results London Total contact Average/pharmacy 111 contacts/pharmacy Response Range across London Kensington & Chelsea Bexley 236 contacts/pharmacy 57 contacts/pharmacy London LAT (average per pharmacy) NE NW SL 120 contacts/pharmacy 128 contacts/pharmacy 93 contacts/pharmacy 95%CI were applied to the data on a borough basis as an assessment of the variation in results 12 Boroughs higher than the London mean 8 boroughs lower than the London mean 13 Borough within 95% CI of London mean Analysis At the time of delivery there were 1844 pharmacies in London therefore the response rate very high at 83.4%. Only 66 submissions were rejected and 33 required adjustment. This demonstrates a very high level of adherence to data collection by responding pharmacies. As with the COPD pharmacy public health campaign, there was significant variation in interventions. In Kensington & Chelsea the average number of contacts was 2.1 times the London average whilst Bexley average was almost half the London average. 24% or 8 boroughs were not statistically different from the London average of 111 contacts/pharmacy. Conclusion The conclusion to question 1 is based upon a 83.4% rate among pharmacies with a very high level of accuracy in responses. 76% boroughs were statistically different from the London average of 111 contacts /pharmacy. This demonstrates huge variations in results across London therefore a huge variation in pharmacy 14

16 practice in the delivery of this intervention. Further analysis is recommended to understand reasons for this variance. The campaign demonstrated the ability of community pharmacy to deliver a public health intervention to a cohort of over 163,000. Further analysis is recommended to quantify any benefit. Further analysis is recommended to establish is there is a correlation between the number of contacts and whether the pharmacy provides NHS immunisation services or private immunisation services Based upon previous response rates for public health campaigns in pharmacy settings the methodology used for data collection the very high response rate the high level of data accuracy This public health campaign has demonstrated a strong potential for future use of community pharmacies to promote seasonal flu and other immunisation services to the population of London 15