Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

Livestock services and the poor

This paper reviews the economic framework for the delivery of livestock services to the poor. It is argued that the demand for livestock products is likely to increase rapidly and the ability of the poor to participate in the opportunities presented by this growth is linked critically to the availability of good service support, both on the input and output side. Governments therefore have a responsibility to supply the necessary public goods (including the institutions and legal frameworks), and the market infrastructure for facilitating the emergence of efficient markets for livestock services. The paper further argues that the dynamics of public policy in developing countries are much more complex than the simple application of economic logic. It is the larger political economy that often dictates policy choices. It is therefore important to integrate political economy and governance issues into the economic debate on livestock service delivery. The paper also reviews the context in which the markets for livestock services will need to function. Different countries are facing very different sets of issues, and the identification of possible interventions in livestock service markets would require careful field research and analysis. In this context, the paper suggests the elements of a research agenda for the next few years.

Technology sourcing, knowledge management and governance in international inter-organizational innovation networks

This conceptual paper aims to improve our understanding of how internationalised firms use outsourcing and offshoring strategies to manage knowledge and information through the life-cycle of integrated product-service solutions. More precisely, we identify the appropriate theoretical framework for this analysis and investigate through in-depth case studies how UK engineering firms organise, coordinate, and incentivise work that is executed in globally distributed teams. Our research focuses on their UK and India offices to study the organisation and governance of distributed teams. The research has several theoretical dimensions - organization; geography; time and knowledge - that it addresses as boundary challenges.

A design of e-procurement infrastructure model for public service sector

Procurement is one of major business operations in public service sector. The advance of information and communication technology (ICT) pushes this business operation to increase its efficiency and foster collaborations between the organization and its suppliers. This leads to a shift from the traditional procurement transactions to an e-procurement paradigm. Such change impacts on business process, information management and decision making. E-procurement involves various stakeholders who engage in activities based on different social and cultural practices. Therefore, a design of e-procurement system may involve complex situations analysis. This paper describes an approach of using the problem articulation method to support such analysis. This approach is applied to a case study from UAE.

Norms-based simulation for personalised service provision

User interfaces have the primary role of enabling access to information meeting individual users' needs. However, the user-systems interaction is still rigid, especially in support of complex environments where various types of users are involved. Among the approaches for improving user interface agility, we present a normative approach to the design interfaces of web applications, which allow delivering users personalized services according to parameters extracted from the simulation of norms in the social context. A case study in an e-Government context is used to illustrate the implications of the approach.

Stakeholder-defined corporate responsibility for a pre-credit-crunch financial service company: lessons for how good reputations are won and lost

This paper presents a study that identifies a stakeholder-defined concept of Corporate Responsibility (CR) in the context of a UK financial service organisation in the immediate pre-credit crunch era. From qualitative analysis of interviews and focus groups with employees and customers, we identify, in a wide-ranging stakeholder-defined concept of CR, six themes that together imply two necessary conditions for a firm to be regarded as responsible— both corporate actions and character must be consonant with CR. This provides both empirical support for a notable, recent theoretical contribution by Godfrey (in Acad Manag Rev 30:777–798, 2005) and novel lessons for reputation management practice.

Community strategies in England: reshaping spaces of governance?

The preparation of Community Strategies (CS) has been required of LSPs and Local Authorities in England since the passing of the Local Government Act 2000. This paper examines the process and content of two Community Strategies in southern England as part of an ongoing project to understand their impact and explore ways that CSs may be carried through in a meaningful and effective manner. The paper concludes that the two CSs studied illustrate the challenge faced by LSPs in producing Strategies that are meaningful, inclusive and which follow the spirit of the government CS guidance. LAs and LSPs are also posed with a difficult challenge of seeing through an implicitly required transition from a traditional representative democratic structure/process with a more fluid participatory model. Thus we detect that at least two forms of conflict may arise – firstly with elected councillors threatened by a loss of power and secondly between communities and the LAs who are encouraged to problematise local policy and service delivery in the context of limited resource availability.

B2B service brand identity: scale development and validation

Several brand identity frameworks have been published in the B2C and the B2B brand marketing literature. A reliable, valid and parsimonious service brand identity scale that empirically establishes the construct's dimensionality in a B2B market has yet to be developed. This paper reports the findings of a study conducted amongst 421 senior executives working in the UK IT Service sector to develop and validate a B2B Service Brand Identity Scale. Following established scale development procedures support is provided for a B2B Service Brand Identity Scale comprising five dimensions; employee and client focus, visual identity, brand personality, consistent communications and human resource initiatives. Concluding remarks discuss theoretical and managerial implications with limitations and directions for future research.

New governance approaches to environmental regulation: an example of the Code for Sustainable Homes (CSH)

Environmental policy in the United Kingdom (UK) is witnessing a shift from command-and-control approaches towards more innovation-orientated environmental governance arrangements. These governance approaches are required which create institutions which support actors within a domain for learning not only about policy options, but also about their own interests and preferences. The need for construction actors to understand, engage and influence this process is critical to establishing policies which support innovation that satisfies each constituent’s needs. This capacity is particularly salient in an era where the expanding raft of environmental regulation is ushering in system-wide innovation in the construction sector. In this paper, the Code for Sustainable Homes (the Code) in the UK is used to demonstrate the emergence and operation of these new governance arrangements. The Code sets out a significant innovation challenge for the house-building sector with, for example, a requirement that all new houses must be zero-carbon by 2016. Drawing upon boundary organisation theory, the journey from the Code as a government aspiration, to the Code as a catalyst for the formation of the Zero Carbon Hub, a new institution, is traced and discussed. The case study reveals that the ZCH has demonstrated boundary organisation properties in its ability to be flexible to the needs and constraints of its constituent actors, yet robust enough to maintain and promote a common identity across regulation and industry boundaries.

The relationship between well-being, future planning and intentions to utilise intervention programmes: what can be learned from homeless service users?

There has been an increasing interest in the impact of individual well-being on the attitudes and actions of people receiving services designed to offer support. If well-being factors are important in the uptake and success of service programmes it is important that the nature of the relationships involved is understood by service designers and implementers. As a contribution to understanding, this paper examines the impact of well-being on the uptake of intervention programmes for homeless people. From the literature on well-being a number of factors are identified that contribute towards overall well-being, which include personal efficacy and identity, but also more directly well-being can be viewed as personal or group/collective esteem. The impact of these factors on service use is assessed by means of two studies of homelessness service users, comparing the implementation of two research tools: a shortened and a fuller one. The conclusions are that the factors identified are related to service use. The higher the collective esteem – esteem drawn from identification with services and their users and providers – and the less that they feel isolated, the more benefits that homeless people will perceive with service use, and in turn the more likely they are to be motivated to use services. However, the most important factors in explaining service use are a real sense that it is appropriate to accept social support from others, a rejection of the social identity as homeless but a cultivation of being valued as part of a non-homeless community, and a positive perception of the impact of the service.