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  • Men's Health
    27 February 2012

    Network Lead Steve Foster invites others to share their own examples of innovation in service design and delivery. In this month's blog, Steve writes about the development of a Men's Health Service in his pharmacy.

 
 
Monday, 27 February 2012

Men's Health

Network Lead Steve Foster invites others to share their own examples of innovation in service design and delivery. In this month's blog, Steve writes about the development of a Men's Health Service in his pharmacy.

Introduction

 

Men are generally pretty rubbish at looking after their own health – and I should know, because I’m one of them! We do our best to avoid our GP at all costs, and tend to bury our heads in the sand, hoping that our problem will simply disappear of its own accord….

 

Unfortunately, in too many cases, this approach can lead to more serious problems in the longer term, and can result in unnecessary suffering and even premature death. Early intervention and primary prevention saves lives, and that is why I am developing a Men’s Health Service at the moment at Pierremont Pharmacy in Broadstairs.

 

The Men’s Health Service will contain three elements, as follows, and I will deal with each one in turn:

 

1.      Full MOT

2.      Erectile Dysfunction Service

3.      PSA Testing Service

 

1. Full MOT

 

We have been offering a (sort of) Men’s Health service for the last few years – re-badging our full Lifestyle Assessment as an “MOT” to attract men to the service, because they understand any analogy to do with cars!

 

We offer an annual check-up (as you would do on your car) which includes weight, height and BMI; an assessment of lifestyle factors such as smoking, alcohol and physical activity; a waist and hip measurement; a check for blood pressure, blood glucose and total and HDL cholesterol; and both a relative and absolute risk assessment of future cardiovascular disease.

 

Once we “suck them in” we can begin to address some of their lifestyle issues and encourage them, for example, to stop smoking, lose weight, eat more healthily or take part in some regular physical activity to improve their risk assessment. If they are found to have an issue with blood pressure, diabetes or cholesterol, we can offer them the appropriate advice or refer them to their GP.

 

This part of the service has proven to be something of a success since its inception, so it has led me to think about what else we could do to attract men to healthcare.

 

Two issues immediately come to mind – Erectile Dysfunction (ED) and the health of their prostates….!

 

2. ED and the supply of ED drugs under PGD

 

Erectile Dysfunction (ED) is embarrassing enough for men to talk about in any case, let alone with a female counter assistant, which is why we are looking at including this in our Men’s Health offering.

 

In the past, we have been forced to refer men with ED to their GP for treatment, but with the introduction of a number of private Patient Group Directions (PGDs) for drugs for ED, we are now able to supply medication such as Viagra, Cialis or Levitra without the need for a prescription.

 

We also offer “EDLP” – everyday low pricing – on our ED drugs to remain as competitive as we can in the market place, and to prevent men from having to shop around every pharmacy in the area to find the best deal. In effect, without losing money, we try to match or beat the price offered by our competitors so that men regard us as their first port of call rather than their last resort.

 

We are currently looking at an offering by “Pharmacy PGD”, a company set up to provide “off-the-shelf” PGDs to independent community pharmacists without having to spend months organising their own. Following a consultation with the (probably male) pharmacist, the patient can be provided with the ED drug of his choice, which is much more convenient than attending his GP surgery and obtaining a private prescription before shopping around for the best price….

 

3. PSA Testing Service

 

We have been working with an organisation called the Graham Fulford Charitable Trust, a charity focused on prostate cancer, for the last year or two. Graham set this charity up in 2004 having sadly lost a good friend and a relative to prostate cancer, both having been diagnosed too late.

 

Over the last seven years the Trust, working closely with David Baxter-Smith, a consultant urological surgeon, has carried out more than 18,000 tests for Prostate Specific Antigen (PSA), a chemical that appears in raised levels in the bloodstream where men have a problem with their prostate glands. As a result of this testing, the Trust has so far found 422 prostate cancers at a much earlier stage than they might otherwise have been diagnosed, and this has undoubtedly saved many lives.

 

We are in the process of setting up PSA testing within our own practice, and intend to offer this as “road shows” as well as in an in-house clinic.

 

We will be using MediWatch PSA Watch Bioscan machines for this work, which are designed to give an “indicative” PSA score within ten minutes of the sample being processed, rather than the fourteen days typically required to process a venous sample through the usual channels.

 

As for the road shows, our intention is to take our PSA testing out to men in their communities by offering a free health promotion evening at four local golf clubs – a typical haunt for men of a certain age! We hope to test fifty men per evening over four evenings in March or April, meaning that we will have tested two hundred men overall in the four events.

 

We have designed the events so that men will be allocated set times in the evening to have their blood taken – a process which should only take ten minutes from start to finish – and will then be counselled by a pharmacist about their results. They will be classed as either “green”, “amber” or “red” depending upon their PSA level in mcg/L, as shown in the following table:

 

Age Range (years)

Green

Amber

Red

Under 50

<2.0

2.0 – 3.0

>3.0

Under 60

<3.0

3.0 – 4.0

>4.0

Under 70

<4.0

4.0 – 5.0

>5.0

70 and over

<5.0

5.0 – 6.0

>6.0

 

If men are currently taking drugs for their prostate function such as Finasteride (Proscar, Peopecia), Dutasteride (Avodart) or a combination (Combodart) then we need to double the value of their PSA reading.

 

The pharmacist will then explain the result to the patient as follows:

 

Ø  “Green” letter – their result is within normal limits, but they need to be aware of any symptoms related to the prostate in the future, and would be advised to have an annual PSA test.

 

Ø  “Amber” letter – their result is close to the upper normal level for a man of their age, and they are recommended to have a follow up test in three to six months.

 

Ø  “Red” letter – this is an abnormal result, but does not necessarily mean that there is anything seriously wrong. The patient should, however, certainly be followed up by their GP. They should also be given a leaflet about possible prostate conditions and a “useful contacts” sheet which will help them to understand the gland more.

 

In addition to this, David Baxter-Smith, the consultant urologist, will follow up the “red” letters after approximately six months and the “amber” letters after approximately twelve months.

 

In this way, we hope not only to drive up the number of cancer finds, but equally importantly improve the quality of life of lots of men suffering from benign conditions that it is vital that we find and treat.

 

Assuming that this works well, we intend to offer it within our practice as part of our expanding Men’s Health offering – so watch this space!

If you would like to share your own experiences of innovation and multi-professional working, please send your article to me by e-mail at stephen.foster@pierremontpharmacy.com.

 

 
toptastictom
toptastictom says:
Mar 04, 2012 10:04 AM
I think that you have done extremely well as I have failed in my aortic aneurysm and testicular cancer ultrasound screening project in West London. As you correctly say, men don't want to know. If you could give em some advice as to how I could rebadge my service I should be most greatfull.
Dr Tom Naunton Morgan MB FRCS FRCR Consultant Radiologist. tom.nauntonmorgan@btinternet.com
foster41
foster41 says:
Mar 04, 2012 02:29 PM
Hi Tom,

Firstly, please don't be too down-hearted about this - it's not a failure; it's more a case of pressing the right buttons.... Well done for trying in the first case!

My own experience is that you often have to overcome a number of different obstacles to get something off the ground, and it becomes very frustrating when you continually fall.

I am very keen to develop the Men's Health offering, and would be happy to talk to you about this in more detail, as I am very interested in what you have had to say.

Feel free to give me a call on my mobile (07540) 047748 if you want to speak more.

Regards,

Steve