North Manchester Hypertension & AF Screening Pilot
In 2018, Manchester Health and Care Commissioning (MHCC) created the ‘Winning Hearts and Minds’ programme which was focused on tackling cardiovascular and mental health inequalities in the city. The programme identified a significant gap between the number of individuals in North Manchester diagnosed with hypertension and atrial fibrillation vs. the predicted prevalence. GMLPC was invited to scope a pilot community pharmacy screening service which was intended to support the Winning Hearts and Minds programme by screening eligible patients for hypertension and atrial fibrillation (AF) through an opportunistic blood pressure measurement with AF indicator.
GMLPC requested CHL’s support in scoping and delivering the service. CHL provided support, information, and costs to MHCC to inform a business case, which was signed off in April 2019, with funding agreed for an 18-month pilot. Following funding authorisation, the project was developed, implemented, and managed by CHL, with MHCC as the commissioner.
CHL worked with the commissioner to:
- Design a service to address the aims & objectives of the programme and to ensure congruence to NICE guidelines, including service specification, pathway, pharmacy resources, and SOP
- Identify & select community pharmacy sites through an EOI
- Set up bespoke PharmOutcomes modules to capture agreed metrics, to allow simple and straightforward data recording for pharmacies and to inform the evaluation of the project
- Create and deliver training for the community pharmacy teams and support set-up of the service
- Source & supply equipment and communication materials
- Provide PMO support throughout, including regular activity reporting
- Provide clinical oversight of the service
- Monitor delivery of project outcomes with pharmacies, providing guidance and support if delivery fell below the defined KPIs
- Manage activity data updates & payment to pharmacies, invoicing the commissioner as appropriate
Patients within the eligibility criteria were recruited into the service by the pharmacy team through proactively offering a BP & pulse check to anyone who entered the pharmacy. The patient’s BP and pulse were taken using the Microlife Watch BP Home A monitor. There was then a referral, follow up or discharge from the service based on the BP and pulse taken. All patients screened were offered brief opportunistic advice on reducing future risk of cardiovascular disease.
Patients requiring follow up were requested to return in 7 days for another BP & pulse check and then entered into a structured follow-up with healthy lifestyle advice if BP was still raised, with follow-ups after 4 and 8 weeks, aiming to reduce BP to below 140/90 where possible. Patients with resistant BP (≥180/110) were referred to their GP for confirmation of diagnosis and treatment initiation as appropriate. Patients with an irregular pulse were referred to their GP for confirmation of an atrial fibrillation diagnosis and treatment initiation as appropriate. Patients with persistent elevated blood pressure after one lifestyle intervention were offered Ambulatory Blood Pressure Monitoring (ABPM) over 24 hours to confirm a hypertension diagnosis prior to referral to the GP. The service pathway can be viewed here.
The pilot service ran for 7 months from September 2019 to March 2020, at which time it was unfortunately suspended due to the COVID-19 pandemic.
213 patients were screened, with 27 being referred to their GP for hypertension, symptomatic hypotension, or suspected AF. CHL prepared a comprehensive evaluation of the service with a selection of patient case studies which can be shared on request.
Due to the early termination of the pilot, unfortunately the results do not demonstrate significant outcomes in terms of numbers, however the concept of community pharmacy being well-placed to find patients who have undiagnosed conditions is appropriate. MHCC and CHL agreed that the pilot clearly showed the vital role community pharmacy has to play in identifying patients with undiagnosed cardiovascular conditions. Indeed, the Pharmaceutical Services Negotiation Committee (PSNC) and the NHSE Pharmacy Integration Fund (PhIF) are currently piloting a similar screening service with a view to it being rolled out and commissioned nationally.