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.

Love of reading: the evaluation of KidsREAD programme in Singapore

In Singapore about 20% of families are considered to be socio-economically disadvantaged. Children from these families have been identified as having reading difficulties when they enter primary school. Recognizing that children from these families have limited access to reading materials, the National Library Board, in partnership with local community clubs and family service centres, has established the KidsREAD literacy programme where volunteers, mostly university and college students, help children between 4 and 8 years of age overcome some of their reading problems. The KidsREAD clubs aim to “promote the love of reading and cultivate good reading habits among all young Singaporeans, in particular children from low-income families” (National Library Board, 2005). This paper presents an evaluation of the KidsREAD clubs with regard to children’s attitudes towards reading. It explores the differences in children’s reading attitudes at the beginning of the programme and half way through the programme. The study was carried out in three representative clubs. This paper evaluates the attitudes of 65 children towards the clubs and the activities conducted at the clubs. It outlines the children’s beliefs about reading and the extent to which they value reading. It further explores how much KidsREAD clubs have influenced their attitudes towards reading in general and their enjoyment of reading in particular.

Analys av en meddelandetjänst vid krissituationer baserat på CBS-tekniken(Cell Broadcast Service)

Uppdragsgivare för detta examensarbete är Länsstyrelsen Dalarna. Målet är att undersöka hur lämplig tekniken med CBS (Cell Broadcast Service) baserade textmeddelande är vid viktigt meddelande till allmänheten (VMA-larm). En tjänst som utnyttjar CBS-tekniken kan rädda liv om allmänheten i ett tidigt skede får reda på vad som hänt och vart de ska bege sig.Rapporten visar på hur man kan använda SMS då en krissituation uppstår. Med hjälp av CBS-tekniken skickas meddelandet till specifikt valda basstationer och alla mobiltelefoner som är uppkopplade mot den. Det positiva är att bara de som behöver få veta vad som hänt får meddelandet.Enligt specifikationerna (ETSI) på GSM och 3G-näten i Sverige finns det stöd för utskick av CBS-meddelanden inbyggt i de befintliga näten. Det finns dock vissa problem vid införandet av CBS-tekniken i operatörsnäten. Operatörerna måste implementera en Cell Broadcast Center (CBC) i näten, denna del av infrastrukturen kommunicerar med basstationerna och sköter utskicken av CBS-meddelanden. Ett ytterligare problem med CBS-tekniken är att användarna måste aktivera mobiltelefonen för att ta emot CBS-meddelanden.Enligt Telia och Vodafone används CBS inte i Sverige idag men vi bedömer att tjänsten för att varna allmänheten kan använda sig av CBS-tekniken om den implementeras i operatörsnäten. Vi har i detta arbete använt oss av en generell kvalitativ metod kompletterat med Siegels metod. Med den kvalitativa metoden har vi intervjuat Telia och Vodafone på ingående fakta om CBS-tekniken. Vid design av teknisk lösning har vi använt oss av Siegels två första faser.

Self-Service Business Intelligence verktyg – möjligheter ochbegränsningar : En jämförelse av teorier om Self-Service Business Intelligence verktyg och praktiska resultat av verktyget PowerPivot

Inom Business Intelligence har begreppet Self-Service Business Intelligence (Self-Service BI) vuxit fram. Self-Service BI omfattar verktyg vilka möjliggör för slutanvändare att göra analyser och skapa rapporter utan teknisk support. Ett av dessa verktyg är Microsoft PowerPivot.På Transportstyrelsens Järnvägsavdelning finns behov av ett Self-Service BI-verktyg. Vi fick i uppdrag av Sogeti att undersöka om PowerPivot var ett lämpligt verktyg för Transportstyrelsen. Målet med uppsatsen har varit att testa vilka tekniska möjligheter och begränsningar PowerPivot har samt huruvida PowerPivot är användbart för Transportstyrelsen.För att få en djupare förståelse för Self-Service BI har vi kartlagt vilka möjligheter och begränsningar med Self-Service BI-verktyg som finns beskrivna i litteraturen. Vi har sedan jämfört dessa med våra testresultat vilket har varit syftet med uppsatsen.Resultatet av testerna har visat att Transportstyrelsens Järnvägsavdelning initialt behöver teknisk support för att använda PowerPivot. Testerna har även visat att vissa av Transportstyrelsens krav inte kan uppfyllas. Detta minskar användbarheten för Transportstyrelsen.Vidare har vi kommit fram till att Self-Service BI inte alltid är enkelt att använda för slutanvändare utan teknisk support. Resultatet visar även att det krävs en BI-infrastruktur för att enkelt skapa rapporter med god kvalitet och högsta möjliga korrekthet.