Week 22 - disease prevention Flashcards
Disease prevention
->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
-Some risk factors for disease and disability are amenable to change (such as personal habits), while others (such as genetic endowment and family
history) are not
-Health promotion involves the development of behaviours that improve bodily functioning and enhance an individual’s ability to adapt to a changing environment
Why is disease prevention important?
-According to the World Health Organization, 80% of chronic diseases are preventable
-Lifestyle choices have more impact on health and longevity than anything else
-The major contributors to chronic disease are an unhealthy diet, physical
inactivity, and tobacco use
-Making healthier choices reduces the risk of early ill health and diseases such
as cancer, cardiovascular disease, stroke, respiratory disease and mental ill-health
Practice healthy living habits
-Eat a healthy diet
-Maintain a healthy weight
-Be active on most days
-Don’t smoke or use tobacco
-Limit alcohol use
Obesity
-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
Alcohol
-Alcohol is the cause of
around 1500 deaths a year
in Wales -> alcohol related deaths are higher in the most deprived areas of Wales
->Estimated cost of £1 billion
of harm to society
-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
UK guidelines - alcohol consumption
->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
Smoking
-Smoking rates have fallen significantly, but smoking still accounts for more years of life lost than any other modifiable risk factor
How smoking harm the body
Heart -> doubles risk of heart attack
Lungs -> causes 84% deaths from lung cancer and 83% deaths from COPD
Circulation -> increases blood pressure and heart rate
Fertility (men) -> can cause impotence in men
Bones -> can cause bones to become weak and brittle, increases risk of osteoporosis in women
Brain -> increases risk of having a stroke by 50%
Mouth and throat -> increases risk of cancer in lips, tongue, throat, voice box and oesophagus
Stomach -> increases risk of stomach ulcers and stomach cancer
Fertility (women) -> can make it harder to conceive
Skin -> skin prematurely ages between 10 and 20 years
Cost to NHS £(billion)
Smoking -> £5.2 B
Obesity -> £4.2 B
Alcohol -> £3.5 B
Physical activity -> £1.1 B
Delivering a healthier Wales: pharmacy
-An estimated 50,000 people a day visit a community pharmacy in Wales
-Community pharmacies are community health assets, physically located in the heart of local populations
-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
Community pharmacy
-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
Key pharmacist roles
-Public awareness campaigns -> provision of leaflets / resources
-Opportunistic counselling / advice with signposting -> make every contact count (MECC)
-Delivering advanced services
National public health campaigns
-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
Antimicrobial Stewardship Campaign 2021
->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 antibiotic
Antimicrobial resistance
-Resistance is a global health disaster that is already killing
700,000 people across the globe each year
-The WHO have declared that AMR is of the top 10 global
health threats facing humanity
Making every contact count (MECC)
-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
The simple 3 As approach
-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
Enhanced services: stop smoking
Stop smoking services:
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
->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
Why are these services important? - smoking
-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 in Wales
->Nearly 1 in 5 of all deaths in this age group
-One in every two smokers die from smoking related diseases
-Passive smoking can lead to a range of diseases, many of which are fatal, with children especially vulnerable
-Smoking costs the Welsh NHS around £302 million per year
Motivating facts for opportunistic contacts - smoking
-Quitting is the most important thing you can do to benefit your health
-The benefits of quitting start straight away -> 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
Enhanced services: vaccinations
Benefits of vaccinations:
-The World Health Organisation estimates that 3 million lives are saved every year worldwide through immunisations - globally there is a huge amount still to do
-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
Vaccine efficacy
-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-19 pandemic
->Misinformation leads to vaccine hesitancy and lower vaccination rates
Vaccine misinformation
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 deaths in the years which followed, with large numbers permanently brain damaged by the disease
->A study 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
MMR and autism
-Series of case-reports published in the Lancet in the late 90s linking the MMR vaccine to autism based on only 12 children
->Paper received wide publicity and vaccinations rates begun to drop immediately
-This has led to measles outbreaks across the UK and other countries, due to higher
levels of unvaccinated adults and children
->The theory has now been completely discredited and the author prosecuted for ethical fraud, despite this even today, this message has not yet got through to a minority
Community pharmacy vaccination services
-One in ten NHS seasonal influenza vaccinations are now provided by pharmacies and pharmacies have played an important role in delivering our
hugely successful COVID-19 vaccination programme particularly in our most
rural areas
-Influenza vaccines can be provide free of charge to patients falling within the “at risk” groups
->Some Pharmacies will also offer a private (paid) service to patients who fall outside of the “at risk” groups
Influenza “at risk” groups
As defined by the “Vaccine Green book”
-65 years or over
-Chronic respiratory disease (including COPD and asthma),
-Significant cardiovascular disease (not hypertension),
-Immunocompromised
-Diabetes mellitus
-Chronic neurological, renal or liver disease
-Pregnancy
-Morbid obesity
COVID-19
Community pharmacies have also played an important role in the COVID-19 vaccination programme -> delivering primary and booster doses for patients
Advantages include:
-Increased convenience for patients
-Improved access for rural areas and for patients without transport to access the mass
vaccination centres
-Trusted and familiar health-care setting which may help address vaccine hesitancy including in hard to reach groups
Sore Throat Test and Treat (STTT) service
-Enhanced service for community pharmacists to manage acute sore throats
-Include use of clinical scoring tools to assess severity (FeverPAIN and Centor
scoring)
-Patient’s scoring high, will be offered a throat swab to check for the presence of bacteria
-If the throat swab is positive the patient will be offered a course of antibiotics by the pharmacist
-If negative, they will be given self-care advice and advised to seek medical attention if they get any worse
STTT - service aim
->Safely reduce antibiotic prescribing for acute sore throats
-Distinguish between viral or bacterial sore throats
-Moving care of these patients to community pharmacy - removes pressure from GP practices
-Allows GPs to spend more time on assessing more diagnostically difficult patients
-Assessment and explanation around why antibiotics are not needed will often take more time than issuing an antibiotic prescription
-Reducing antibiotic prescribing is important to reduce the spread of antibiotic resistance, which is a major threat to health-care
STTT pilot results
Original pilot results:
-72% (n=1239) of patients screened were eligible for antigen testing
-28% (350) were positive for GABHS, 27% (340) received antibiotics
->Overall service prescribing rate was 20% (340/1725) patients
-Prescribing rates in SBUHB for GP consultations is 70%
Future roles
Prevention of cardiovascular diseases, through early screening and detection?
Health screens:
-Cholesterol
-Blood pressure
-Diabetes screening
-Waist circumferences
