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Establishing Population Health Management Clinic (PHMC) in surgical pre-assessment unit at WMUH

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European Statement

Clinical Pharmacy Services

Author(s)

Thewodros Leka

Why was it done?

Population Health Management is about improving population health by data driven planning and delivery of proactive care to achieve maximum impact.
The aim was to Introduce ‘Making Every Contact Count’ approach in the pre-assessment unit of engaging in conversations with patients about their lifestyle and providing the tools and information they need to make meaningful changes in managing
 Hypertension, Diabetes
 Smoking, Consuming alcohol, high BMI
 Regular physical exercise, Healthy eating schedule
 Adherence to prescribed medicines
In addition, establish link with the community public health team for continuous intervention and support.

What was done?

We proposed to the hospital executive management board to develop and test a novel clinical nurse and pharmacist led ‘Population Health Management clinic’ for the hospital that is grounded in connections to key stakeholders in the community, so that patients are followed up to get lifestyle change interventions to improve their illnesses and medication adherence. The board approved the funding and we established the first of its kind population health management clinic in the hospital.

How was it done?

Obtaining funding for the project was an obstacle.
We surveyed 1,000 patients who attended the pre-assessment unit during the year.
31% were hypertensive, 13% diabetic, 12% were smokers, 29% had anxiety/ depression, 51% drink alcohol more than recommended limit; 50% have BMI >29; 41% were not adherent in taking their regular medicines, 41% do not practice any physical exercise and 50% said they do not follow healthy eating. We presented the audit data to the hospital executive management board proposing to develop a ‘Population Health Management clinic’. The board approved the funding as they found that this is a step forward to improve the health of the population.

What has been achieved?

Since the initiation of the project, the concept of proactive health intervention and life style change approach is well established in the hospital becoming daily practice of the pre-assessment team.

What next?

Establishing Population health management clinic in surgical pre-assessment unit provides a unique ‘teachable moment’, where a patient can be encouraged by a perioperative team to make positive and lasting changes to their lifestyle and medication adherence.

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