Comparison of two methods for assessing diabetes risk in a pharmacy setting in Australia.

BACKGROUND: Since 2007, the Australian Know your numbers (KYN) program has been used in community settings to raise awareness about blood pressure and stroke. In 2011, the program was modified to include assessment for type 2 diabetes risk. However, it is unclear which approach for assessing diabetes risk in pharmacies is best. We compared two methods: random (non-fasting) blood glucose testing (RBGT); and the Australian type 2 diabetes risk assessment tool (AUSDRISK); according to 1) identification of 'high risk' participants including head-to-head sensitivity and specificity; 2) number of referrals to doctors; and 3) feasibility of implementation. METHODS: 117 Queensland pharmacies voluntarily participated and were randomly allocated to RBGT and AUSDRISK or AUSDRISK only. Although discouraged, pharmacies were able to change allocated group prior to commencement. AUSDRISK is a validated self-administered questionnaire used to calculate a score that determines the 5-year risk of developing type 2 diabetes. AUSDRISK (score 12+) or RBGT (≥5.6 mmol/I) indicates a high potential risk of diabetes. Median linear regression was used to compare the two measures. Staff from 68 pharmacies also participated in a semi-structured interview during a site visit to provide feedback. RESULTS: Data were submitted for 5,483 KYN participants (60% female, 66% aged >55 years, 10% history of diabetes). Approximately half of the participants without existing diabetes were identified as 'high risk' based on either RBGT or AUSDRISK score. Among participants who undertook both measures, 32% recorded a high RBGT and high AUSDRISK. There was a significant association between RBGT and AUSDRISK scores. For every one point increase in AUSDRISK score there was a half point increase in RBGT levels (coefficient 0.55, 95% CI: 0.28, 0.83). Pharmacy staff reported that AUSDRISK was a simple, low cost and efficient method of assessing diabetes risk compared with RBGT, e.g. since management of sharps is not an issue. CONCLUSIONS: In a large, community-based sample of Australians about half of the participants without diabetes were at 'high risk 'of developing diabetes based on either AUSDRISK or RBGT results. AUSDRISK was considered to be an acceptable method for assessing the risk of diabetes using opportunistic health checks in community pharmacies.

Australian public's awareness of stroke warning signs improves after national multimedia campaigns.

BACKGROUND AND PURPOSE: The aim of this study was to examine the reach and impact of the National Stroke Foundation (NSF) multimedia stroke warning sign campaigns across Australia. METHODS: A total of 12 439 surveys were performed across 6 states during 6 years on random state-weighted samples of Australians≥40 years old. RESULTS: Awareness of stroke advertising increased 31% to 50% between 2004 and 2010 (P<0.001), as did the unprompted recall of ≥2 most common stroke warning signs 20% to 53% (P<0.001). Awareness of stroke advertising was independently associated with recalling ≥2 common signs (adjusted odds ratio=1.88, 95% confidence interval [1.74-2.04]; P<0.001). Awareness was not greater in respondents with previous stroke or risk factors, except atrial fibrillation. CONCLUSIONS: The Australian public's awareness of stroke warning signs has improved since commencement of the NSF campaigns commensurate with greater awareness of stroke advertising. Public education efforts are worthwhile, and future efforts should focus on groups identified with low awareness or those at high risk of stroke.

The Know Your Numbers (KYN) program 2008 to 2010: impact on knowledge and health promotion behavior among participants.

BACKGROUND: Since 2007, the National Stroke Foundation in Australia has undertaken a community-based 'Know Your Numbers' program on blood pressure and other stroke risk factors. AIMS: The aims of this study are to assess, in a sample of registrants participating in a three-month follow-up survey, retention of knowledge of risk factors and health conditions associated with hypertension, and whether those who were advised to see their doctor sought treatment or performed other health promotion actions. METHODS: Various organizations (mainly pharmacies) were recruited to offer a 'free' standardized blood pressure check and educational resources for one-week/year between 2008 and 2010. Data collection was done thru registration log and detailed questionnaires for a sample of registrants at baseline and three-months. Descriptive statistics were used for comparison of baseline and three-month data. RESULTS: There were 59 817 registrants over three-years. A total of 2044/2283 (90%) registrants completed a baseline survey (66% female, 50% aged >55 years); 43% had blood pressure ≥140/90 mmHg whereby 32% were unaware of their blood pressure status. Follow-up surveys were obtained from 510/805 (63%) baseline participants who provided consent. At three-months, improved knowledge was found for 9 of 11 risk factors for hypertension (e.g. lack of exercise baseline 73%; three-months 85%, P < 0·001). Knowledge for all the health conditions assessed that are associated with hypertension improved (e.g. stroke baseline 72%; three-months 87%, P < 0·001, heart attack baseline 69%; three-months 84%, P < 0·001). All respondents reported at least one health promotion action. Among 141/510 advised to visit their doctor, 114 (81%) did. CONCLUSION: Know Your Numbers is a successful health promotion program and encourages people to be reviewed by their doctor.

Feasibility of a pilot programme to increase awareness of blood pressure as an important risk factor for stroke in Australia.

BACKGROUND: Reduction of blood pressure represents one of the most effective means of reducing stroke risk. However, lack of community awareness and uncontrolled blood pressure remain a significant problem. In 2007, the National Stroke Foundation (Australia) conducted the 'Know Your Numbers' pilot programme to improve community knowledge, based on a similar UK programme developed by the Blood Pressure Association. We aimed to determine the success of the pilot in improving knowledge and in identifying factors to improve the programme. METHODS: Pharmacy Guild of Australia and Rotary International recruited volunteers to provide a 'free' blood pressure check and educational resources between 25 and 27 October 2007 via 'pressure stations'. evaluation methods: registration log and a survey of a 'one in 10 sample' at baseline and 3 months. Data were analysed using descriptive statistics. RESULTS: 77 out of 104 pressure stations returned data. The median tested per pressure station: 29 (interquartile range 19, 50), 66% tested by pharmacy and 32% by Rotary. Of the 2834 registrants (58% female, 55% aged >55 years), 46% had 'high' readings (>140/90 mmHg). Of those with high readings, 45% reported no history of high blood pressure and one-third of the registrants were unaware of their blood pressure level. There was evidence of improved knowledge at the 3-month follow-up, with most participants with high blood pressure (85%, n=22) being reviewed by their doctor. CONCLUSION: The 'Know Your Numbers' pilot programme was a successful model for improving knowledge of blood pressure as an important stroke risk factor and encouraging individuals with high blood pressure to be reviewed by their doctor. Further programmes with evaluation are being planned.