cardiovascular risk assessment at the pharmacy may identify the population at risk
DESCRIPTION
Cardiovascular risk assessment at the pharmacy may identify the population at risk. Joep Perk, Kalmar, Marianne Norelius, Stockholm Sweden Amsterdam 2014-05-08 Declaration of interest Joep Perk: Nothing to declare Marianne Norelius:Employed by Apoteket AB. - PowerPoint PPT PresentationTRANSCRIPT
Cardiovascular risk assessment at the pharmacy may identify the population at risk
Joep Perk, Kalmar, Marianne Norelius, Stockholm
Sweden
Amsterdam 2014-05-08
Declaration of interest
Joep Perk: Nothing to declare
Marianne Norelius: Employed by Apoteket AB
Why provide a health check-up at a community pharmacy?
Over the past 20 years overweight and obesity in the population has doubled in Sweden
Total costs for health care and loss of income caused by sick leave or premature death due to diet, physical activity, alcohol and tobacco, have been estimated to more than 5 billion EUR per year in Sweden (9 million inhabitants)
The primary health care situation is strained
The needs and demands of the pharmacy clients
Apoteket´s mission is to make it easier to live a healthy life
The 100 community pharmacies (out of our 370) that provide the health check up today have good accessibility and more than 25.000 customer visits per day
Shows how to have anown impact on one's health
Includes:- health questionnaire- blood pressure- total cholesterol- blood glucose- waist circumference
30 minutes meeting with aspecially trained pharmacist
Is offered to community pharmacy clients as well as to employees at B2B-customers as a part of their Occupational health programme
The Health Check-up
Step by stepThe client books an appointment on Apotekets website and fills in the health questionnaire on the web
A specially trained community pharmacist performs the tests and the client gets immediate feed back on his possibilities to lower his CVD risk
The client has the opportunity to reflect on his/her living habits and his motivation to change. He/she can decide on a focus-area (start exercising, better eating habits etc) to improve his/her health
Photo: Håkan Lindgren
Timeline atherosclerosis
Foam cell Fattystreak
Intermediarylesion
Atheroma Fibrousplaque
Complicatedlesion/rupture
Low risk Moderate risk High risk Very high risk
Development of atherosclerosis over time
All Females SD Males
Age + SD 45,3 13,5 45,9 13,1 44,1 12,8N 21483 14262 66,4 7221 33,6Blood pressure % % %N 21450 14237 66,4 7212 33,6 > 140 mm Hg 3819 17,8 2059 14,4 1760 24,4 > 90 mm Hg 3701 17,3 2192 15,4 1508 20,9
Cholesterol % % %N 20636 13628 66 7008 34> 5mmol/l 8789 42,6 5935 43,6 2854 40,7
Results all participants
Blood glucose All % Females % Males %
N 10809 6317 4492
> 6,1 och < 7.0 mmol/l 1207 11,2 730 11,6 477 10.6
> 7,0 mmol/l 510 4,7 299 4,7 211 4,7
SCORE N 16160 10157 6003
1-5% 3238 20,0 1721 16,9 1517 25,3
> 5% 517 3,2 83 0,8 434 7,2
Waist circumference
N 21394 14183 66,3 7211 33,7
Risk zone: f. 80-88 cm, m. 94-102 cm 4466 31,6 2249 31,1
Adiposity: f.> 88 cm, m. >102 cm 4460 31,5 1369 19
Results all participants
All SD Females SD Men SD
Occ Health
N 10139 5675 56% 4464 44%
Age 41,4 yr 10 41,2 10,2 41,7 7,8
PharmacyN 11 344 8587 75,7% 2757 24,3%
Age 48,7 yr 15,2 49 15 47,9 15,8
Results occupational health vs com pharmacy
Blood pressure All % Females % Males %
Occupational health
> 140 mm Hg 1379 13,6 452 7,8 927 20,7
> 90 mm Hg 1455 14,4 645 11,3 810 18,1
Pharmacy > 140 mm Hg 2440 21,5 1607 18,7 833 30,2
> 90 mm Hg 2245 19,8 1547 18,0 698 25,3
Results occupational health vs com pharmacy
Cholesterol All % Females % Males %
Occ Health
> 5mmol/l 3239 31,9 1669 29,4 2501 35,2
Pharmacy > 5mmol/l 5550 48,9 4266 50.1 1284 46,8
Blood glucose All % Females % Males %
Occ Health
> 6,1 and < 7.0 mmol/l
676 9,5 329 9,0 347 10
> 7,0 mmol/l 256 3,6 120 3,3 136 3,9
Pharmacy
> 6,1 and < 7.0 mmol/l
531 14,7 401 15,3 130 13
> 7,0 mmol/l 254 7 179 6,8 75 7,5
Results occupational health vs com pharmacy
Results occupational health vs com pharmacySCORE All % Females % Males %
Occ Health1-5% 1520 15 446 7,9 1074 24,1> 5% 151 1,5 11 0,2 140 3,1
Pharmacy1-5% 1718 28,5 1275 28,4 443 28,8> 5% 366 6,1 72 1,6 294 19,1Waist circumference
All % Females % Males %
Occ Health
Risk zone: f. 80-88 cm, m. 94-102 cm
2952 29,3 1637 29,1 1315 29,5
Adiposity: f.> 88, m. >102 cm
1838 18,2 1197 21,3 641 14,4
Pharmacy
Risk zone: f. 80-88 cm, m. 94-102 cm
3763 28,3 2829 33,1 934 34,0
Adiposity: f.> 88, m. >102 cm
3991 30,0 3263 38,2 728 26,5
Most confounding findings…..
More than 40% of all clients had a cholesterol value >5 mmol/l
> 60% of women and > 50% of men had an elevated waist circumference or even manifest adiposity
A significant number of prediabetes/diabetes cases were detected
One in five men had a high blood pressure
One in five men attending the pharmacy had a SCORE level above 5%, thus being at high cardiovascular risk
From more than 20.000 health check-ups we conclude that it is relevant to provide cardiovascular risk assessment at community pharmacies as it contributes to identifying a significant part of the population at an elevated risk.
We meet clients with a risk scenario from very low risk to high risk and we refer all clients at medium risk to high risk to their doctors
The results in general show that an important part of the clients have one or more elevated CVD risk factors and therefore should take action to improve their lifestyle
The Pharmacy group is at a significant higher risk than the Occupational group
The next step is to evaluate to what extent the health check up has had an impact on clients behaviour and if it has led to a more healthy lifestyle and a lowered CVD risk
Conclusions and Next Step
ContactsJoep Perk Marianne [email protected] [email protected]
+46 73 676 0901 +46 70 628 80 70www.apoteket.seTwitter: m_norelius
Thank you for your attention!