Public health qualifications, motivation, and experience of pharmacy professionals: exploratory cross-sectional surveys of pharmacy and public health professionals.

BACKGROUND: Pharmacy professionals (pharmacists and pharmacy technicians; PPs) are recognised for delivering public health interventions (micro level). There is increased policy focus on population health management, but limited knowledge regarding the role of PPs within UK's public health meso and macro levels. This study aimed to explore UK PPs' public health qualifications, specialisations, and motivations and barriers to pursuing advanced public health practice. METHODS: In this cross-sectional study, we developed and piloted two surveys, and we disseminated them separately via email to UK pharmacy and public health networks and social media, between June 19, and Oct 26, 2021. PPs with an interest or experience in public or population health were invited to participate in the study. We asked PPs questions about public health qualifications, specialisations, motivations, and barriers, and we also asked PHPs for opinions regarding the value of specialist public health skills for PPs. Numerical data were summarised, and responses collated into themes. NHS Health Research Authority tool identified ethics approval not required; and the questionnaire included consent request. FINDINGS: 128 PPs (85% pharmacists) and 54 PHPs responded. Of the PPs who responded, 90 (70%) were female and 35 (27%) were male; 62 (48%) were White British, 19 (14%) were Asian or Asian British, 14 (12%) were Black or Black British. They worked in primary care (34%, n=43), secondary care (26%, n=33), Community Pharmacy (13%, n=16), and public health bodies (13%, n=16). Overall, 34 (27%) of 128 PPs (32 pharmacists; 2 pharmacy technicians) possessed public health qualifications (MPH, PhD). Motivations for these qualifications were ambition to work as PP in public health PP (31%; 17/55 respondents), public health as alternative career (29%; 16/55), general interest (27%; 15/55) recommended or required for current role (11%; 6/55). Themes of barriers included limited training opportunities and poor career pathways. For the PHP survey, 36 (67%) of 54 were female and 16 (30%) were male. They worked as Consultants or Directors (28%, n=15), Registrars (24%, n=13), Practitioners (15%, n=8). 45 (87%) of 52 PHP respondents agreed that specialist PPs in public health would be beneficial to public health; 13 (45%) of 29 respondents recommended a public health Master's degree, eight (27%) recommended experience or postgraduate modules in health economics and health inequalities, three (10%) recommended credentialing for PPs to specialise. INTERPRETATION: Findings suggest responding PPs are motivated to advance in public health practice, despite barriers. Collaboration with PHPs and development of communities of practice might address barriers identified and contribute to advanced public health practice for PPs, supporting the increased focus on population health management in the UK. Limitations include the exploratory nature of the study, and the fact that PPs responding to public health surveys might be more motivated to advance in public health practice than those not responding. FUNDING: NHS England and UK Health Security Agency.

Medical morbidity and risk of general hospital admission associated with concurrent anorexia nervosa and COVID-19: An observational study.

OBJECTIVE: Investigate medical morbidity and risk of general hospital admission for patients with concurrent coronavirus disease 2019 (COVID-19) and anorexia nervosa (AN) who have not received severe acute respiratory syndrome coronavirus 2 vaccination. METHODS: United Kingdom eating disorders clinicians contributed to a database of patients with an eating disorder and COVID-19. We used this to investigate demography, symptoms, hospitalization, treatment, and outcomes for those with AN. RESULTS: We describe data for 49 patients (median age 21.5 years [interquartile range 17.0-33.5], 46 female) including 36 adults and 13 under-18-year-olds. Three (6.1% [95% confidence interval 1.3%-17.9]) were admitted to a general hospital. For this sample, the expected age-standardized hospital admission rate per COVID-19 case (based on the general population of England) was 2.6% and therefore not significantly different to the hospitalization rate we observed. Three (including two of those admitted to hospital) contracted pneumonia. One had severe pneumonia and was admitted to an intensive care unit. No deaths or use of mechanical ventilation were recorded. DISCUSSION: To our knowledge, this represents the first study investigating medical morbidity or frequency of hospitalization for patients with COVID-19 and AN. We did not find evidence that patients with AN are at increased risk of severe COVID-19. PUBLIC SIGNIFICANCE: Medical morbidity and risk of hospitalization associated with concurrent COVID-19 and anorexia nervosa (AN) had not, to our knowledge, been studied before. We used a database of patients with eating disorders and COVID-19 (to which United Kingdom clinicians had contributed) to investigate presentation, treatment, outcomes, and COVID-19 severity for those with AN and COVID-19. We did not find evidence that patients with AN are at increased risk of severe COVID-19.

Successful weight management and health behaviour change using a health trainer model.

AIM: NHS Great Yarmouth and Waveney is an area of high deprivation and it is estimated that 49% of the adult population are overweight or obese. The health trainer model, which involves recruiting trainers from local communities, offers an innovative way of supporting individuals in managing their weight through one-to-one support. The aim of the current study was to evaluate the effectiveness of a health trainer-led intervention in terms of weight loss and behaviour change. METHODS: Data were collected from all participants who visited a health trainer for the purpose of weight loss between February 2008 and March 2011. All participants were seen on a one-to-one basis, with the setting and length of the intervention varying according to individual requirements (median 21 weeks, IQR 12.4-29.6). Weight change was the primary outcome measure; secondary outcomes were blood pressure, fruit and vegetable intake and physical activity levels, measured using established health trainer data recording systems. Data on secondary outcomes were not available for all participants due to lack of compliance. RESULTS: Using intention-to-treat analysis, average weight change was -2.5 kg (95% CI - 2.7 - -2.1, n = 541, p < .001) and weight gain was prevented in 90% of participants (n = 487). The number of participants classified as hypertensive reduced from 60% (n = 66) to 41% (n = 45) over the period of the intervention. In terms of behaviour change, fruit and vegetable intake increased significantly by 2.4 portions per day (95% CI 2.1-2.7, n = 248, p < .001) with 46% (n = 115) of participants increasing their intake to five portions per day. 68% of participants for whom data were available (n = 227) reported an increase in moderate physical activity, with time increasing by 59.3 minutes per week (95% CI 46.3-72.4, p < .001). CONCLUSIONS: The health trainer service in Great Yarmouth and Waveney may be effective in helping participants to manage their weight and change their health-related behaviour. Although the degree of weight loss reported was moderate given the high levels of deprivation and the health needs of the local population, these were promising findings. To improve the current evidence base for the effectiveness of health trainer-led interventions, studies need to see if these findings are replicable in other population groups and in other settings.