Tag Archives: results

Conducting your own audit of evidence

Apr 2012

Getting evidence from services is no longer a luxury for pharmacy. With the new NHS bill, every healthcare professional and service will have to demonstrate value if they want a future.
However, collating evidence has been a particular challenge for pharmacy – pharmacists are not in the habit of documenting the value of their services and they often don’t have the means to do this efficiently, relying too much on paper.
Conducting an audit and gathering evidence for your service is easier if you have an online recording system and the PSNC are going that way with Pharmabase.
When it comes to your weight management service, the evidence from your audit can be compelling. Using the Lipotrim Patient Tracker, you can pull off data to demonstrate benefits using a range of criteria, for example by gender, BMI, age and co-morbidities such as hypertension and diabetes, all at the click of a button. It allows you to continuously audit your pharmacy service for evidence based commissioning while at the same time monitor and support your patients and cut down on paperwork and filing.
Getting started is easy. Draw up objectives and then decide on what evidence you want to present, to whom and for when. Set aside time to become familiar with the Lipotrim Patient Tracker or simply book a quick 20-minute online demo to see it in action and get your first patient record in place.

PDF Version: ICP LIPOTRIM COLUMN april

AUDIT RESULTS USING THE LIPOTRIM PATIENT TRACKER BY PHARMACIST GARETH EVANS

Audit Results using the Lipotrim Patient Tracker

by Gareth Evans

The current excitement generated by the press coverage of the Newcastle University study of diabetic patients using weight loss by a very low calorie diet to “cure” diabetes, necessitates a wider recognition of the well established programmes already available. The Lipotrim weight loss programme, monitored exclusively by healthcare professionals has been in extensive use in the UK for more than 25 years. A rapidly expanding network of nearly 2000 pharmacies currently offer the VLCD service and although many have used manual methods to audit their patients’ achievements, the newly provided Patient Tracker computer software for managing patient records has permitted continuous auditing of results and detailed evaluation of population subsets.

For example, in addition to auditing the total experience of patients enrolled in the pharmacist-run service, the results can be examined in many different ways. The cohort can be divided by gender, by age, by initial or final BMI, by amount or percentage of weight loss achieved, or by medical history (hypertension, diabetes, depression, thyroid problems etc.). The programme extends beyond weight loss, as there is a refeeding transition back to ordinary foods and a full maintenance programme, which is proving extremely successful in the pharmacy environment. With this Tracker audit tool, therefore, evidence is also available documenting the long term maintenance outcome after dieting.

As a pharmacist who has been using the Tracker to keep my Lipotrim patients’ records for some time now, I would like to share a current audit of my patients’.

Materials and Methods

Overweight or obese people requesting the programme are assessed for suitability on the basis of initial BMI and a detailed medical history. Those requiring medical cooperation, such as those with type 2 diabetes or medicated hypertension make suitable arrangements with their GP prior to dieting or are excluded. Those with contraindicated conditions, such as insulin dependant diabetes or pregnancy are excluded from the programme.

Suitable candidates follow a strict regime of total food replacement using nutrient complete formulas, essentially very low fat enteral feeds, with adequate fluid intake and only black tea or coffee permitted in addition. Appropriate prescribed medications are continued as well. No other foods, beverages or supplements are permitted.

Dieters are monitored and weights recorded weekly – only 1 week’s supply of formulas can be obtained at each visit and obvious non-compliance is corrected or the dieter is offered alternative weight loss advice.

Records are maintained on the Patient Tracker programme.

 

Results

Total Population of Dieters completing 3 or more weeks on Total Food Replacement

Mean Start Weight 91 kg – Mean End Weight 81 kg

Total weight lost to date of audit – 3865 kg

 

Table 1 N= 382 330 Females 52 Males

Mean Start wt 91kg Start BMI 32.7 End BMI 29.0 % wt loss 10.8
Median Start wt 88.2 kg Start BMI 32.0 End BMI 28.4 % wt loss 9.0

The next series of tables demonstrates the value of the Lipotrim service in overweight patients, reducing the likelihood of their progression to obesity, as well as obese, super obese, morbid obese or even super-morbid obese patients.

 

Table 2 N= 121 BMI 25-30

Mean Start BMI 28.1 End BMI 25.4 % wt loss 9.3
Median Start BMI 28.3 End BMI 25.4 % wt loss 8.0

 

Table 3 N= 141 BMI 30-35

Mean Start BMI 32.4 End BMI 28.9 % wt loss 10.9
Median Start BMI 32.3 End BMI 29.1 % wt loss 12.0

 

Table 4 N= 73 BMI 35-40

Mean Start BMI 36.9 End BMI 32.4 % wt loss 12.9
Median Start BMI 36.7 End BMI 32.6 % wt loss 11.0

 

Table 5 N= 29 BMI 40-45

Mean Start BMI 42.2 End BMI 36.1 % wt loss 14.4
Median Start BMI 42.0 End BMI 36.3 % wt loss 11.0

 

Table 6 N= 5 BMI 45-50

Mean Start BMI 47.4 End BMI 37.2 % wt loss 21.2
Median Start BMI 47.3 End BMI 36.9 % wt loss 22.0

 

 

Other subsets of the patient information that are of interest include:

 

Table 7: Obese people who exceeded the 5% criterion for medical benefit of weight loss.

 

Tables 8and 8a: Some dieters choose to interrupt their diet for varied reasons and then return for a subsequent diet period. Their first and second dieting courses can be examined separately.

Table 9: After a period of weight loss, it is necessary to re-introduce carbohydrates in a controlled manner to minimise weight regain due to carbohydrate loading. Minimal weight change is expected despite reintroduction of normal foods. This phase is 1 week long.

Table 10: The Tracker software distinguishes between periods of dieting and maintenance providing evidence of minimal recidivism when patients are properly supported in the pharmacy environment.

Table 7 N= 231 BMI > 30 who lost 5% or more of initial weight

Mean Start BMI 35.3 End BMI 30.8 % wt loss 12.7
Median Start BMI 34.5 End BMI 30.1 % wt loss 11.0

 

Table 8 N= 78 Dieters who had 2 dieting courses First time

Mean Start BMI 32.1 End BMI 29.1 % wt loss 9.0
Median Start BMI 31.2 End BMI 28 % wt loss 7.5

Table 8a N= 78 Dieters who had 2 dieting courses Second time

Mean Start BMI 31.1 End BMI 29.6 % wt loss 4.7
Median Start BMI 29.7 End BMI 28.1 % wt loss 3.5

 

Table 9 N= 140 Refeeding week

Mean Start BMI 27.5 End BMI 27.4 % wt loss -.2
Median Start BMI 26.6 End BMI 26.6 % wt loss 0

 

Table 10 N= 249 Maintenance after dieting

Mean Start BMI 28.1 End BMI 28.1 % wt loss 0.1
Median Start BMI 27.2 End BMI 27.0 % wt loss 0

 

Patients who are medicated for various weight related ailments can often be considered as different categories of patient. Many hypothyroid patients have experienced great difficulty with weight management. Depression and hypertension often have a weight component in the aetiology of the problem.

Table 11: Examines patients on medication for hypertension

Table 12: Examines patients on medication for hypothroidism

Table 13: Examines patients on medication for Depression

 

Table 11 N= 22 Patients with High Blood Pressure

Mean Start BMI 36.2 End BMI 32.0 % wt loss 11.6
Median Start BMI 37 End BMI 32.2 % wt loss 8.5

 

Table 12 N= 9 Patients with thyroid hormone replacement

Mean Start BMI 34.5 End BMI 29.4 % wt loss 14.2
Median Start BMI 34.7 End BMI 28.9 % wt loss 10.0

Table 13 N= 13 Patients with Depression

Mean Start BMI 33.2 End BMI 28.2 % wt loss 13.0
Median Start BMI 32.2 End BMI 28.9 % wt loss 11.0

 

Discussion

The extreme flexibility of the Patient Tracker software, in addition to documenting and visualising each individual patient’s experience, allows for presentation of evidence of the weight loss achievements of cohorts of patients. This has become important for commissioning and the new ability of grouping patients from an individual surgery permits certification to the surgery of the collective progress of their patients, These results can be of value for CPD as well.

As can be seen from the multiple tables presented as illustration, the percentage of initial weight lost generally averages well over 5% and in most cases over 10%. Even the median values, which documents the half-way values of the ranges, are generally very close to the mean. Successful weight loss is found even in the extremely high BMI patients, who are usually refractory to weight management attempts.

In addition to demonstrating the successful loss of weight by the dieters, regardless of the sub-category for grouping, it is important to note that even though there are some variations in patients’ experiences with re-feeding (Table 9) and follow on maintenance (Table 10), the overall lack of weight regain from the patients post-diet demonstrates the value of the pharmacist and the Lipotrim programme for long term weight control.

 

 

Conclusion

Despite the fact that these results reflect the efforts of a single pharmacist in a programme that currently lists nearly 2000 pharmacies throughout the UK and Ireland, it is important to have the tools that can satisfy the need for documentation of achievement in this era of evidence-based treatments. The success of this pharmacy service has considerably enhanced my professional satisfaction as a pharmacist.

 

 

 

 

COULD LIPOTRIM VLCD TREAT YOUR OBESE DIABETIC PATIENTS AND REDUCE YOUR PRESCRIBING COSTS?

The NHS is reported to be spending £9 billion a year treating diabetes ineffectively File on Four. BBC Radio 4 21 February 2012.)

3-2imgPerhaps the most important contributory cause to the rise in diabetes in recent years is overweight and obesity, yet a cost-effective, evidence-based option for treating the condition appears to be being overlooked. Rapid weight loss using a very low calorie diet (VLCD) regime has been shown to normalise blood sugar levels within a few days, requiring withdrawal of hypoglycaemic medication. 1,2 VLCD also lowers the risk factors for cardiovascular disease.

Bariatric surgery is another recognised method of weight reduction for obese patients with diabetes. However, the effect
on blood sugar is stronger with VLCD than with bariatric surgery as post-surgical nutrition includes a significant amount of carbohydrate, thus preventing the rapid utilisation of blood sugar and glycogen stores fundamental in a ketogenic VLCD. Furthermore, while there are around three quarters of a million patients who meet the NICE criteria for eligibility for bariatric surgery, the health system barely begins to meet the demand and last year less than 9000 operations, NHS and private combined, were performed.

Lipotrim is a well-established VCLD programme, supervised by GPs or pharmacists, which has been running successfully for over 25 years. GPs can monitor their patients on the programme themselves, although the monitoring task is usually provided by pharmacists who also supply the Total Food Replacement products. The programme has the additional advantage of being cost neutral to the NHS as the products are not ordinarily prescribed, while the cost to patients is usually more than compensated by the reduction in their food bills. Lipotrim refeeding and maintenance programmes are available for patients to maintain their weight at the reduced level once a target has been achieved.

Abundant evidence is available of the success of Lipotrim VLCD programmes run in UK pharmacies. More than 2000 pharmacies offer the service and many record their patients’ progress using Patient Tracker software, which produces
detailed audits providing substantial evidence of efficacy across a wide spectrum of patients and medical conditions. For example, audit results from 400 patients treated in one pharmacy have recorded an average weight loss of 11% across all clients after three or more weeks on the Lipotrim programme. 3
Percentage of initial weight lost by patients in this group reached as high as 37%. Average percentage weight loss rose with increasing BMI at outset, from 9% loss in clients with a BMI of 25-30, to 13% with starting BMI of 35-40 and 21% for those with starting BMI of 45-50. The figures also show that weight losses were maintained during refeeding and maintenance after dieting. There is also evidence from the Tracker that an average weight loss of around 14% can be
achieved on the Lipotrim programme by hypothyroid patients, who generally experience great difficulty with weight
management. And average weight losses of 12-13% in patients with hypertension and depression, conditions to which
excess weight can be a contributory factor, have also been shown.

For further information, contact Valerie Beeson, Clinical Programme Director, Howard Foundation Research Ltd. Cambridge UK. E-mail: obesity@lipotrim.demon.co.uk. Phone:01223 812812.

References
1. Paisey RB, et al. An intensive weight loss programme in established type 2 diabetes and controls: effects on weight and
atherosclerosis risk factors at 1 year. Diabet Med.1998; 15:73-9.
2. Paisey RB, et al. Five year results of a prospective very low calorie diet or conventional weight loss programme in type 2 diabetes. J Hum Nutr Diet. 2002;15:121-7.)
3. Pharmacist Gareth Evans, Waistaway Ltd. Data on file.

PDF version:3-2-BMJ-May-2012