Conducted at Priory Community Pharmacy in Dudley, the project evaluates the feasibility and acceptability of integrating cardiovascular-related health checks into routine vaccination services. This innovative approach aims to improve patient access to preventative healthcare, expand the role of community pharmacists, and reduce pressures on the broader NHS system. As the project progresses, several key lessons and reflections have emerged that provide valuable insights for future implementation and replication – a hallmark of good research.
Needs assessment: Laying a Foundation for Success
At the heart of Priory REACH lies a commitment to understanding what service users want in an integrated healthcare service, rather than relying solely on expert preferences and assumptions of what they believe patients need. Collaboratively designing the intervention with both the people who will use and deliver the service makes it more likely that the intervention will maximise its impact and success. By prioritising co-design, we hope this will result in a blueprint for a feasible, acceptable, and sustainable intervention that can have a positive impact on population health.
Elicitation Research: Identifying Barriers and Facilitators
Elicitation research has been instrumental in shaping the Priory REACH intervention. As part of the ongoing needs assessment, interviews, surveys, and observations with both patients and community pharmacy staff has revealed several operational gaps and opportunities for improvement:
Training Gaps: Pharmacy staff raised concerns about their confidence in operating the CardioChek device used for measuring blood pressure, cholesterol and blood glucose. To address this, dedicated training sessions were introduced incorporating MECC (Make Every Contact Count) training to empower staff to initiate personalised health discussions with patients to identify relevant health checks based on their individual needs.
Resource Constraints: A new laptop was provided for use in the designated health check room, as well as other project materials such as posters, promotional adverts, and information leaflets describing the service. The ongoing requirement for test strips posed a potential financial limitation which was resolved by collaborating with Alphega, who generously supplied test strips free of charge.
Referral Pathways: Establishing referral routes for patients identified as being at risk of cardiovascular disease (CVD) has also been challenging. Currently, we are working closely with three local General Practices in Dudley – St James, Eve Hill, Greens – to follow up on patient outcomes to ensure some form of continuity of care and evaluating whether this ‘care transition’ between community pharmacy and GP practice is feasible. Additionally, efforts are underway to develop a referral pathway to a local Atrial fibrillation (AF) clinic to allow quicker access to treatment for those at high risk of CVD.
Operational Challenges and Solutions
The Priory REACH health check service is now live. We are currently in the process of collecting data for the evaluation. Despite careful planning though with our stakeholders, we encountered some operational challenges during the winter vaccination period late last year that should be borne in mind when planning and designing future research programmes at the PDA.
Low participation in interviews: Recruitment for pharmacist interviews was unfortunately lower than anticipated (n=2). Consequently, we have recently decided to amend the programme so that we can disseminate surveys to PDA members as an alternative to interviews.
Optimising data collected on PharmOutcomes: The initial PharmOutcomes form used to record patient data was lengthy and time-consuming, taking 20 to 30 minutes to complete. This resulted in a revised version of the form which better aligns with our Priory REACH goals and outcomes, reducing completion time to 15 minutes or less. Additional refinements based on staff feedback have allowed staff to complete a patient record across multiple sessions rather than in one sitting.
Patients who agree to return for their health check: Many patients agreed to return later for their health checks because of time constraints, but many have failed to turn up for their free check. To tackle this going forward, we will increase our efforts to highlight the benefits of participating in Priory REACH, inform them about the service in advance of their pharmacy visit, send reminders to patients who have agreed to have a health check, and provide flexible appointment times.
Stakeholder Engagement: Building Strong Partnerships
The successful implementation of Priory REACH depended on fostering strong collaboration among a range of stakeholders, including pharmacists, GPs, public health specialists, and patient representatives. Regular meetings and open transparent communication helped to build trust and alignment around the projects shared goals.
GP Collaboration: Early involvement of GPs ensured their support for the integrated service, reducing resistance to change. Discussions focused on concise reporting of blood pressure scores and ensuring correct coding to avoid duplication of work.
Patient Representatives: Two patient representatives joined the stakeholder group late last year, providing us with invaluable perspectives on what the community would find attractive in an integrated service in their local pharmacy, and to ensure a patient-centred approach to intervention development.
International Impact: The project has attracted interest from international partners, highlighting its potential for application in other contexts. Further, presentations at key conferences and knowledge transfer events have further increased awareness and generated enthusiasm for replicating this new way of working elsewhere. In our stakeholder and Steering group, we have on board Dr Piotr Merks, who has advised on intervention design and we have had conversations on how our integrated service model can be adapted for implementation within a Polish context.
Blueprint for an Integrated Service: Scalability and Replicability
One of the primary objectives of the Priory REACH project is to create a replicable blueprint for integrating health checks into vaccination services – a model that can be scaled across other community pharmacies nationwide. Successfully achieving this though requires careful consideration of scalability, resource allocation, and adaptability to a range of contexts.
Although it is still early days, we have come across the following key factors that need to be considered for this blueprint.
Standardisation Without Compromising Flexibility: While standardisation of processes ensures consistency, flexibility allows for adaptation to different pharmacy contexts.
Leveraging Digital Technology for CVD-related Checks: Electronic tools such as CardioChek enable rapid point-of-care testing for CVD, whilst platforms like PharmOutcomes help facilitate GP referrals for further investigations. Plans to integrate smartphone apps for home blood pressure monitoring demonstrate the potential of technology to enhance Priory REACH service delivery.
Continuous Improvement Through Feedback Loops: The blueprint will include mechanisms for ongoing evaluation and iterative refinement. Performance metrics including user feedback will be used to monitor outcomes and pinpoint areas for improvement, ensuring that the service remains responsive to evolving needs and changing contexts.
Reflections on Dissemination and Future Directions
The Priory REACH project demonstrates the potential of integrating health checks into vaccination services within community pharmacies. Its success depends on the four main aspects discussed: Identifying user needs to ensure relevance and acceptance, unpacking barriers and facilitators via elicitation research, addressing operational challenges, and stakeholder engagement. Consideration of these will also help to inform a scalable blueprint for successful implementation across different contexts nationwide.
Further, by prioritising patient-centred design, consulting the evidence base (via a scoping review), and fostering collaborative partnerships, the project has created a model that holds promise for transforming how preventative care is delivered. Moving forward, disseminating these lessons through conferences, publications, and international collaborations will be vital to improving the impact of this innovative way of working. Looking ahead, potentially securing funding through funding steams like Horizon Europe grants could sustain and expand the project’s impact. Continued collaborative efforts with organisations like Alphega and the Medication Optimisation Support Hub (MOSH) will help to improve service delivery and outreach. PDA initiatives like Priory REACH also highlight the importance of understanding – and meeting – the needs of the public and what can benefit them above all else. We will provide another update on learnings and findings once the evaluation is complete.
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Learn more
- PDA supports a wider healthcare role for pharmacists
- PDA attends Aston University’s Knowledge Transfer Partnership showcase event
- Knowledge Transfer Partnership website
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