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More needs to be done to detect people’s increased risk of health problems, and new technology is starting to show the way, writes Charles Gladwin

The rise in diabetes cases shows no sign of slowing down. Diagnoses increased by 163,000 in 2012-13 to 3.2 million, and with the trend being upward, Diabetes UK says more preventative action is needed.

It is concerned that not only are people unaware they might be at risk, but that detection is not early enough for them to get the maximum benefit from management options. “The dramatic increase in cases of type 2 diabetes which we have seen in current years costs the NHS £10 billion a year,” says Simon O’Neill, director of health intelligence and professional liaison at Diabetes UK. “So if the government wants to reduce this enormous cost – and we can’t understand why it wouldn’t – we need to see it intervening to ensure that the rise in cases is stemmed.”

One way of doing this, Mr O’Neill suggests, is through the already established, but poorly implemented, NHS Health Check programme. This has the potential to identify people at high risk of type 2 diabetes and give them the support they need to reduce their risk of developing the condition, he says.

The combined efforts and commitment from pharmacists, GPs and local authority providers from across England is crucial to the successful delivery of the NHS Health Check programme

Introduced in 2009, the NHS Health Check had a ‘reboot’ in 2013 to encourage greater uptake. The aim is to invite people in the 40-74 year-old age range for a health ‘MOT’ every five years. As this equates to offering the check to 20 per cent of the cohort each year, the 2013-14 achievement of 18.5 per cent was not far off.

Where there is much more room for improvement, though, is actual uptake: currently this is about 50 per cent of those offered the health check. Preferably, target uptake should be nearer 75 per cent.

Further concerns

Adding to the concerns is a study published in August by the British Journal of General Practice. This found that, in GP practices providing NHS Health Checks, any change in the prevalence of diabetes and cardiovascular disease did not differ from that of practices providing usual care.

The study, conducted by Public Health Warwick, compared 38 practices providing health checks to 41 not doing so, over three years. A total of 16,669 checks took place, which identified 1,142 previously undiagnosed cases of diseases. “Despite this, there were no significant differences in the change to the prevalence of diabetes, hypertension, chronic heart disease, and atrial fibrillation in practices providing NHS Health Checks, compared with control practices,” say the researchers.

Another study has questioned cost- effectiveness. Research from the University of Exeter found that a new diagnosis of hypertension could cost a GP practice up to £550 if found via an NHS Health Check, but half as much through opportunistic screening.

But with community pharmacy increasing its involvement in public health and often being less costly than GP practices, is the NHS Health Check a natural fit for pharmacies? Community pharmacies are already commissioned to deliver the check, for example in Portsmouth, South West London and Norfolk, and Public Health England would like to see more.

“The combined efforts and commitment from pharmacists, GPs and local authority providers from across England is crucial to the successful delivery of the NHS Health Check programme,” says Jamie Waterall, national lead for the NHS Health Check Programme at PHE.

The programme provides an opportunity for pharmacies to play a critical role to help prevent people developing conditions such as heart disease, stroke, kidney disease, type 2 diabetes and certain types of dementia, says Mr Waterall. “A number of local areas are already delivering the programme through community pharmacies and expanding on this success is important to realise the full potential of the programme. PHE will continue to work with pharmacies as the role they play in the community can make a real difference to people’s health locally and nationally, helping to reduce health inequalities.”

And there are plenty of other initiatives for pharmacy to get involved in, if not yet commissioned for the NHS Health Check. An example was Arrhythmia Alliance’s Heart Rhythm Week, which saw over 600 pharmacies offering free blood pressure and heart rhythm tests in June. Over 100 of the pharmacies were in the North East London LPC area, and such was the success there that the scheme ran for an extra month.

Advances in technology

The way health is monitored is changing. PHE’s own work has shown the positive impact that mobile health (mHealth) can make, and over the summer PHE signed up to the WHO and ITU (International Telecommunication Union) global initiative, ‘Be He@lthy, Be Mobile’.

Shortly afterwards, Professor Kevin Fenton, PHE national director for health and wellbeing, blogged: “Smart phones can already accurately measure your heart rate, automatically count how many steps you take, scan a barcode and tell you how much sugar is in it, remind you to buy carrots when you are next in Tesco, and more.”

Digital public health and, in particular, mobile health is at a “tipping point”, he says. “It’s not just health improvement where mHealth has potential, either – we also know that SMS reminders significantly increase screening uptake and more evidence of impact seems to emerge every day.”

Diagnostic equipment reflecting this is already being sold through pharmacies. As an example, Omron says that devices such as its new wrist blood pressure monitors can be used for remote monitoring, making it easier for patients and health professionals alike.

Such products are starting to incorporate near field communication (NFC) technology, “making it quick and easy to transfer a patient’s blood pressure readings to other devices such as a laptop or PC,” says Omron.

NFC is the technology being used in the new generation of credit cards, and seen in the London Transport Oyster cards, as well as smart phones, which allows a signal to be sent from one device to another by touching or being held in close proximity. Omron has launched an ‘ultra thin wrist monitor’ which uses NFC, allowing users to connect to Omron’s new ‘Bi-LINK’ cloud service to track and trend blood pressure readings.

Even the equipment that has been around for many years can be improved and made more accurate. Coinciding with the Stroke Association’s ‘Know Your Blood Pressure’ campaign, Omron launched its M6 Comfort blood pressure monitor, which has been designed to reduce the risk of inaccurate readings.

It incorporates the Intelli Wrap Cuff, designed to fit so that the user doesn’t need to worry about the positioning of the cuff over the artery. It has a longer inner tube that wraps all the way round the arm, rather than partially, giving it a 30 per cent larger contact zone with the artery. This ensures high accuracy and easier measuring, no matter where it is positioned, even at 180 degrees to the artery, says Omron.

Taking the temperature

Another age-old device that has been brought well and truly into the 21st century is the thermometer. Braun says its latest digital thermometers have “breakthrough technology” as they incorporate ‘Age Precision’ software to input the age of the child, and a colour-coded display quickly gives an indication of whether the child has a fever or not.

As marketing manager Andrea Halabrinova explains: “Clinical research indicates that the definition of fever changes with age – so what is classed as a high fever in a newborn can be an acceptable temperature for a four year-old. The Age Precision feature enables the user to set the age of their child, taking the guesswork out of interpreting the temperature reading.”

Braun’s ExacTemp guidance system also addresses concerns over whether a digital ear thermometer has been positioned properly to give an accurate reading. Another feature is that the tip of thermometer is pre-warmed before use, which stops the tip cooling the area within the ear where the temperature is to be taken.

Braun is not the only manufacturer improving ear thermometer technology. Omron Healthcare uses infrared technology to ensure accurate results with a display given in one second. It can also be used to take the room temperature, and surface temperatures, for example of a milk bottle or food dispenser.