19. Disease Prevention

Question 1

What is disease prevention?

Answer 1

Disease prevention involves actions to reduce or eliminate exposure to risks that might increase the chances that an individual or group will incur disease, disability, or premature death

Question 2

What are the different risk factors for disease and disability?

Answer 2

Some are amenable to change such as personal habits i.e. smoking
Some are genetic i.e. family history

Question 3

What is health promotion?

Answer 3

Health promotion involves the development of behaviours that improve bodily functioning and enhance an individual’s ability to adapt to a changing environment

Question 4

Why is disease prevention important?

Answer 4

WHO states that 80% of chronic diseases are preventable

Lifestyle choices have more impact on health and longevity than anything else

Question 5

What are the major contributors to chronic diseases?

Answer 5

An unhealthy diet, physical inactivity and tobacco use

Making healthier choices reduces the risk of early ill health and diseases such ascancer,cardiovascular disease,stroke,respiratory diseaseandmental ill-health

Question 6

What is the advise to practice healthy living habits?

Answer 6

Eat a healthy diet
Maintain a healthy weight
Be active on most days
Don’t smoke or use tobacco
Limit alcohol use

Question 7

Why is obesity detrimental to health?

Answer 7

Obesity and poor diet are linked with type 2 diabetes, high blood pressure, high cholesterol and increased risk of respiratory, musculoskeletal and liver diseases.

Obese people are also at increased risk of certain cancers, including being three times more likely to develop colon cancer.

Question 8

Why is alcohol detrimental to health?

Answer 8

Alcohol increases the risk of conditions including cardiovascular disease, cancer and liver disease. It can also cause emotional and relationship problems

The immediate risks of heavy drinking include alcohol poisoning and harm from accidents, violence and self-harm.

All put substantial pressure on the NHS

Question 9

What are the UK guidelines on alcohol consumption?

Answer 9

The UK Chief Medical Officer’s guidelines on low risk drinking recommend that adults should not regularly drink more than 14 units of alcohol a week.

People who drink as much as 14 units a week are advised to spread their drinking over three or more days in the week.

If people want to cut down, they should try having several drink-free days each week

Women who are pregnant, or who think that they could be, are advised that it is safest not to drink at all

Question 10

Why is smoking detrimental to health?

Answer 10

Doubles the risk of a heart attack
84% of deaths from lung cancer and 83% from COPD are caused from smoking
Increase blood pressure and heart rate
Can cause impotence/infertility in both men and women
Can cause brittle and weak bones
Increases osteoporosis (weak and fragile bones) in women
Increases risk of having a stroke by at least 50%
Increases risk of cancer in mouth and throat
Prematurely ages skin by 10-20 years

Question 11

What is in place to help people live healthier lives?

Answer 11

Pharmacy: Delivering a healthier wales scheme - April 2019

All pharmacies will become health and wellbeing hubs.

All members of the pharmacy teams in patient facing roles will become health and wellbeing ambassadors with skills in health coaching, health literacy, behaviour change and cultural awareness

Question 12

How do community pharmacies play a role in ‘a healthier wales’?

Answer 12

Pharmacies represent the first point of contact within the health system for many communities, and, as such, play an important educational role.

Convenience of access and making every contact count are key aspects of any prevention strategy.

Most community pharmacies have a consultation room offering privacy to patients, their carers or any member of the public, often without the need for an appointment.

Question 13

Key pharmacist roles in ‘a healthier wales?

Answer 13

Public awareness campaigns
Provision of leaflets / resources

Opportunistic counselling / advice with signposting
Make every contact count (MECC)

Delivering advanced services e.g. stop smoking and vaccines

Question 14

What are national public health campaigns?

Answer 14

Co-ordinated approach across Wales

Supported by Community Pharmacy Wales

Leaflets, posters and other resources utilised by community pharmacy staff to start discussions with patients

Question 15

What is the anti microbial stewardship campaign 2021?

Answer 15

Aims to support community pharmacists and patients in joining the fight against antibiotic resistance

CPs ideally placed to advise patients on the importance of only taking antibiotics when their prescriber advises and that antibiotics don’t work for colds and other viral infections

An antibiotic checklist can be used to ensure the antibiotic is appropriate and prescribed safely and to ensure that patients are aware of key messages around antibiotics

Question 16

What is an antibiotic checklist?

Answer 16

An antibiotic checklist is to ensure the antibiotic is appropriate and prescribed safely and to ensure that patients are aware of key messages around antibiotics

Question 17

What is antimicrobial resistance?

Answer 17

It is one of the top 10 global health threats increasing to be the top cause of death, above cancer, by 2050

Question 18

What is MECC?
(Making every contact count)

Answer 18

Making Every Contact Count (MECC) is an approach to behaviour change that uses the millions of day-to-day interactions that organisations and people have with other people to support them in making positive changes to their physical and mental health and wellbeing.

MECC is simply a chat about health.

With a focus on what a person thinks they may be able to do to make a positive change to their lifestyle.

They are often about ‘planting a seed’ for change or supporting someone to make a small step towards making a change.

Opportunities will arise during routine encounters within the Pharmacy

A quick conversation can start a patient on the right path to making healthier choices

Question 19

What is the 3 As approach?

Answer 19

Ask:individuals about their lifestyle and changes they may wish to make, when there is an appropriate opportunity to do so

Advise: appropriately on the lifestyle issue/s once raised

Act: by offering information, signposting or referring individuals to the support they need.

Question 20

Why are stop smoking services important?

Answer 20

Smoking is a leading cause of preventable death in the UK.

Estimated that smoking is responsible for >5000 deaths each year in people aged 35 and over inWales
nearly 1 in 5 of all deaths in this age group.

Incredibly, one in every two smokers die from smoking related diseases

Passive smokingcan lead to a range of diseases, many of which are fatal, withchildren especially vulnerable

Smoking costs the Welsh NHS around £302 million per year.

Question 21

What opportunists are there to provide advise on smoking?

Answer 21

Many smokers per day pass through a pharmacy and staff are ideally placed to opportunistically provide brief interventions on stopping smoking and increase access to stop smoking products.

This may be picked up, for example, when nicotine-stained fingers are observed, the purchase of a smokers toothpaste or repeated requests for cough remedies.

Question 22

What are some motivating facts for motivating stop smoking?

Answer 22

Quitting is the most important thing you can do to benefit your health.

The benefits of quitting start straight away. It’s never too late to stop.

Within 3 days your taste and smell will start to improve, breathing will become easier and energy levels increase. After 1 year the risk of you having a heart attack will fall to half that of a smoker.

Stopping smoking saves money. Stopping smoking 20 cigarettes a day will save you over £2,000 a year.

Protecting loved ones:
- People who breathe second-hand smoke are at risk of the same diseases as smokers, including cancer and heart disease.
- Children exposed to second-hand smoke have a higher risk of bronchitis, pneumonia, asthma attacks and ear infections.

There is plenty of support available to stop smoking. You are four times more likely to stop smoking using an NHS Stop Smoking Service than if you try to quit alone.

Question 23

What are the benefits of vaccinations?

Answer 23

The World Health Organisation estimates that 3 million lives are saved every year worldwide through immunisation

However, globally there is a huge amount still to do -400,000 children still die every year from measles alone, when a safe effective vaccine has been available for over 30 years.

It is important that all children and babies are immunised

The risks of vaccination are very small compared to the risks of getting the diseases themselves

Question 24

What is vaccine efficacy?

Answer 24

Once common illnesses such as diphtheria and
tetanus are now rare because of immunisation.

While polio was declared eliminated in Europe in 2002 through immunisation, the threat of other diseases such as measles and meningitis have not gone away in the UK today.

Vaccination has played a pivotal role in the management of the COVID-10 pandemic

Misinformation leads to vaccine hesitancy and lower vaccination rates

Question 25

What is vaccine misinformation?

Answer 25

A vaccine scare in the UK in the 1970s, resulted in a fall in whooping cough immunisation:
Leading to over 100,000 cases of whooping cough.
An estimated 100 deathsin the years which followed, with
Large numbers permanently brain damaged by the disease.

Astudy investigating the risk later reported that acute reactions did occur, but full recovery was usual. There was insufficient evidence to say DTP increased the overall risk of long-term damage

Pharmacists are also well placed to address vaccine hesitancy and worries.

Question 26

Community pharmacy and vaccination services

Answer 26

1/10 influenza vaccine services now held within community pharmacies free of charge for people in the ‘at risk’ category - or at a charge for people who fall outside of this category

Question 27

Who is in the influenza ‘at risk’ category?

Answer 27

In the ‘vaccine green book’:
- 65 or over
- Chronic respiratory disease (COPD/asthma etc)
- Significant cardiovascular disease (not hypertension)
- Immunocompromised
- Diabetes mellitus
- Chronic neurological, renal or liver disease
- Pregnancy
- Morbid obesity

Question 28

Community pharmacy and COVID-19

Answer 28

Important role by delivering primary and booster vaccines
Advantages are:
- Convenience for patients
- Improved access for rural areas and patients who cannot get to vaccine centres
- Trusted and familiar healthcare setting

Question 29

What is Sore Throat Test and Treat (STTT)

Answer 29

• Enhanced service for community pharmacy to manage acute sore throat
• Includes use of clinical scoring tools to assess severity (FeverPAIN and Centor scoring)
• Patients scoring high will be offered a throat swab to test for bacteria
• If swab is positive, the patient will be offered a course of antibiotics
• If negative, they will be given self care advice and advised to seek medical attention if symptoms worsen

Question 30

What is the service aim of STTT?

Answer 30

• Safely reduce antibiotic prescribing for acute sore throats by distinguishing between bacterial and viral
• Removes pressure from GP practices
• Assessment and explanation around why antibiotics may not be needed which takes more time, again taking pressure off GP
• Reducing antibiotic prescribing is important to reduce the spread of antibiotic resistance

Question 31

What are possible future roles for a community pharmacist?

Answer 31

Prevention of cardio vascular diseases through early screening and detection.
Health screens:
- Cholesterol
- Blood pressure
- Diabetes screening
- Waist circumferences