Presented by Nicky Muscillo B Pharm

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Pharmacy - The Front Line for Weight Management
Support
Australia is the first country in the world where
Xenical has been scheduled to a Pharmacist Only
Medicine. This product is a test for Community
Pharmacy in Australia and if handled correctly
may be the first of many.

• Presented by Nicky Muscillo B Pharm
  
  

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A pharmacy program to help customers lose weight
for life

• A unique collaborative effort between the Guild,
• Pharmaceutical Society, QCPP, AIPM, Wholesalers
  and Roche
• to help ensure Community Pharmacy is ready for
  the challenge
• and can implement and manage this product and
  program
• efficiently and effectively.

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Outline

• Brief overview of Obesity in Australia
• Brief overview of Xenical and how it works
• Brief overview of evidence based medicines and
  how this relates to the weight loss category
• Pharmacy as a weight loss destination
• Support Material for Xenical
• The Lifeweight Program and how it works in your
  Pharmacy

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How big is the obesity problem?
1. Obesity in Australia

• In Australia 56 of adult Australians are
  overweight or obese
• (37 overweight, 19 obese)
• Healthcare costs associated with treating the
  effects of this epidemic are approximately 800m
  per annum
• Research amongst overweight or obese patients has
  shown
• - 92 felt excess weight had a negative effect
  on their lives
• - 49 suffered from lack of energy, problems
  with mobility, or
• an inability to participate in sports
  and recreational pursuits

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Obesity is a world-wide problem
1. Obesity in Australia
Australia

• Australia does not compare favourably

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Are people not trying to lose weight?
1. Obesity in Australia

• Despite the fact that 50 percent of Australian
  adults have tried to lose weight in the past two
  years, 70 percent fail in their attempt to
  achieve their goal weight and one in five will
  proceed to regain all their weight loss, plus
  more.
• With 60 percent of Australians overweight or
  obese, it is evident that traditional methods of
  weight loss such as diet and exercise are often
  not entirely effective on their own. Therefore,
  losing weight successfully and for the long term
  is a very real challenge.

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How do we define overweight and obese?
1. Obesity in Australia
The cut-off points for BMI are however,
arbitrary, either based on statistical data from
reference populations or on the increased
morbidity and mortality associated with
increasing body fat content.8 BMI weight
(kg)/height (m2)
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Orlistat mechanism of action
2. Xenical Overview
Enzymes in your digestive system, called lipases,
help digest fat. When taken with meals, XENICAL
attaches to the lipases and blocks them from
breaking down some of the fat you have eaten.
The undigested fat cannot be absorbed and is
eliminated in your bowel movements. XENICAL
helps block about one-third of the fat in the
foods you eat from being absorbed by your body.
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What evidence is there that Xenical works?
2. Xenical Overview

• Clinical studies have demonstrated that the
  average weight loss with Xenical after three
  months of treatment is 8kg and after seven
  months, patients can expect to lose approximately
  11kg.
• Additionally, after 12 months of treatment waist
  circumference is reduced by 10.8cm.
• Further studies have shown that weight loss is
  successfully maintained in the long term amongst
  people taking Xenical, with almost twice as many
  Xenical treated patients losing more than 10
  percent body weight at the end of four years of
  treatment (26 vs. 16).
• Xenical has been the most comprehensively studied
  weight loss treatment to date with 48,000 people
  having participated in 126 global studies. In
  Australia, clinical trials have been conducted at
  64 centres involving over 700 Australians.
• Since it was first introduced, over 15 million
  people worldwide have been treated with Xenical,
  with more than 250,000 in Australia alone.

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One European 2 Year Trial
2. Xenical Overview
2 Year European Orlistat Trial Mean weight Loss
and Maintenance at Year 1
BMI / 30 BMI 27-29 with at least one major
co-morbidity
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What is Evidence Based Medicine ?
3. Evidence Based Medicine

• If a product is stocked in a pharmacy there is an
  assumption by the consumer that the product
  works. Evidence Based Medicine is an approach
  which allows to you to systematically check if a
  product can back up its claims. Many products
  sold are based on hearsay anecdotal evidence.
  Consumers expect more from pharmacies than other
  retailers.
• Posing the right question (How you ask the
  question will affect the answer)
• Accessing the best information (Ask your
  pharmacist if you are unsure)
• Appraising the information (Level of Evidence,
  discusses next slide)
• Applying the information (Empower the consumer
  with the real facts)
• Evaluating the outcomes (Record results and ask
  customer to come back)

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Levels of evidence
3. Evidence Based Medicine

• Level 1 Systematic review of all relevant
  randomised controlled trials (RCT)
• Level 2 At least ONE R.C.T.
• Level 3 (I) Well designed, pseudo-randomised
  controlled trial
• (ii) Comparative trials,time series w/ current
  controls, not randomised
• (iii) Comparative studies with historical
  control, no parallel group
• Level 4 Case series, pre and post test.
• Level 5 Expert opinion , n1 anecdote
  (Celebrity)

BEST LEVEL
LOWEST LEVEL
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Why is Pharmacy NOT a Weight Loss Destination?
4. Pharmacy as a weight loss destination

• Pharmacy historically has not been seen as a key
  stakeholder in the area of weight management. We
  do not have an effective referral network to GPs,
  Dieticians etc
• Doctors are disappointed pharmacies sell
  products that have little evidence that they
  work.
• Pharmacy does not generally allocate space to a
  designated Weight loss Category area
• Weight management by its very nature is a complex
  psychological and physiological process and
  requires more that selling a product.
• Xenical, The Xenical Educational Material and
  Lifeweight will change Community Pharmacy to
  being considered as a frontline weight loss
  destination.

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Support Materials The following has already been
sent to all pharmacies as well as PSA Members
5. Support Material for Xenical
AIPM/ PGA Info for Pharmacy Assistants
PSA Xenical Protocol
Letter shows industry wide support
PSA CPE
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X-Plan Hot line 1800 000529
5. Support Material for Xenical

• The X-Plan Program is an existing program
• The X-Plan Program is a supplement to the
  treatment offering by pharmacy with over the
  phone together with educational information packs
  sent via mail.
• The X-Plan Program combines various core elements
  to help people achieve long-term weight loss by
  providing
• Detailed information to better understand the
  role of weight loss medication
• Advice to establish specific and realistic weight
  loss goals
• A diet and lifestyle plan to improve eating
  habits and increase activity
• On-line support where patients can look up
  information on the treatment.

Studies have shown people who take Xenical lose
an average of 8.4kg when enrolled on the X-Plan
Program for four months.
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Weight loss solutions/ products galore!Consumers
are confused- they need support !
6. Lifeweight Program
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The Key Elements of Losing Weight
6. Lifeweight Program

• Eating right
• Exercise
• Emotional support
• Medicine support if needed

Lets build a program called Lifeweight and make
it the consumers first choice!
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The Consumer is NOT buying a product they are
buying a solution to lose weight
6. Lifeweight Program
Lifeweight maintenance (feel good, look good,
remove unnecessary risks) Ongoing repeat sales,
increased customer loyalty, visiting more often,
other conditions to manage, only at my pharmacy
Outcome
Journey to Lifeweight goal may be 12 weeks,
perhaps more. Xenical (or evidence based
product Plus add on support)
Loyalty
Solution
Xenical, Optifast, Fatblaster Any pharmacy will
do, any retailer. Price controls consumer Choice.
(No loyalty)
Product or service
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What is the key to a good program?
6. Lifeweight Program

• Pharmacy staff perform consistently. (QCPP
  requires consistency)
• (Same on Monday morning as on Saturday afternoon)
  
• Access to staff when consumer wants it
• (Dont just have one staff member trained)
• Well signed in the pharmacy
• (Use the material Lifeweight provides to
  advertise service)
• Staff Confidence is important
• (Understand program as your confidence consumer
  confidence)
• Successful patients will tell others
• (Focus on getting it right for first 3 months
  success will follow)

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Lifeweight Questions
6. Lifeweight Program

• When will it be available?
• (It will be available in mid-July. Consumer
  Xenical launch after Olympics)
• How much does it cost?
• (It costs 330 GST included, but over 2400
  pre-orders have been placed by pharmacy
  wholesalers and pharmacists allowing purchase of
  higher quality equipment eg scales. Check with
  your banner group/ wholesaler)
• Why is official pharmacy so supportive of
  Lifeweight
• (Lifeweight will provide a consistent industry
  wide approved weight loss solution. It will
  immune pharmacy from criticism from groups such
  as the AMA)
• Now let us step through the program

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6. Lifeweight Program
Create a Weight Loss Category

• Your Pharmacy will be provided with a
  600mm wide roadmap which will form the
  centre piece of a weight loss section.
• Allocate area for materials
• Area should be located in or adjacent to
  the professional area.
• You are encouraged to place all weight loss
  products in section including vitamins, OTC,
  Xenical etc

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Point consumers to the weight loss
departmentOnce a consumer is there step through
the solution
6. Lifeweight Program

• Your Pharmacy will be provided with shelf
  talkers.
• Other material is used to point people to weight
  loss section eg signage to put in vitamin section
• Lifeweight material list
  being finalised now

Shelf strips
A3 window posters
Jjgf jfhgsjhf isfksf ihsfhsf Jsgfjgsfs kshhskfh
Tent cards
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The Roadmap 600mm x600mm wide board
6. Lifeweight Program

• To position the pharmacy as navigator through
  options. (When something is important people need
  a navigator)
• To show the right way
• To arrest and impact on customers attention
• To position pharmacy as legitimate first choice
  (but it has to be earned through delivery of
  services)
• Easy for staff to remember the steps
  (copy in handouts)
• 1200mm x 600mm version available

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The Value Proposition
6. Lifeweight Program

• Initially talk about solution. No talk about any
  product.
• Be honest there are no quick fixes. Dont
  push yourself too hard
• We are here to help because you cant do it alone

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Step by step Roadmap
6. Lifeweight Program

• The Essentials
• Eat right Healthy eating plan is available
  resource on Lifeweight CDRom. Does your pharmacy
  stock calorie counters? opportunity? Build
  category
• Exercise chart brochure is part of Lifeweight
• Helps set targets- exercise zone chart is age
  dependent and male and female different
• Safe exercise
• Develop alliances Personal trainers, local
  gyms, walking clubs

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6. Lifeweight Program
Step by step Roadmap

• Build on the Essentials
• Treatment help
• Helps list options including medicines, meal
  replacement, surgical treatments. Do not go into
  detail here. If patient wants detail refer to the
  pharmacist
• What is the Right Medicine brochure is part of
  Lifeweight
• Eg Good evidence that many OTC products contain
  stimulant ingredients which are completely
  ineffective- ephedrine caffeine
• Eg Low effectiveness - brindleberry, Alphalipoic
  acid, chromium (except in insulin resistance),
  Chitosan, Fibre supplements
• Xenical is evidence based

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6. Lifeweight Program
Step by step Roadmap

• Copy of 5 Steps Losing Weight for Life in
  handouts

• Get help here
• Start today
• The 5 Step Guide brochure is part of Lifeweight
• It covers the solution approach to weight loss
  you have already started talking to your customer
  about.
• This brochure is our statement that Community
  Pharmacy is ready to be taken seriously as a
  weight loss destination
• 1/ Are you too fat? Find out the facts
• 2/ Eat right
• 3/ You have to do some exercise
• 4/ If its safe, why not take the right medicine
• 5/ You definitely shouldnt do it alone

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6. Lifeweight Program
Step by step Roadmap
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6. Lifeweight Program
Step by step Roadmap
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6. Lifeweight Program
Step by step Roadmap

• LIFEWEIGHT includes what you need to monitor
  patients
• 150kg Scales
• Tape measures
• BMI calculators

• BMI needed to establish suitability for Xenical
• Weekly monitoring of weight in minimum time
  needed to maintain support network
• Lifeweight includes other support materials
  previously mentioned
• XPlan can be added support structure for
  patients including phone support

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6. Lifeweight Program
Pharmacy Assistants can gather preliminary data
for Pharmacist
Patient Record Form- 1st Visit (Top front page)

• BMI will vary
• slightly depending on
• system used

Orlistat is indicated for treatment of
obese patients with a body mass index (BMI) of
30 or overweight patients with a BMI of 27 and
the presence of one or more co-morbidities.

• The Excel spreadsheet in Lifeweight calculates
  BMI by use of
• Chest cm, Hip cm, Waist cm
• Or use - BMI calculators on Lifeweight CD Rom
• Or use - Roche BMI chart Lifeweight CD Rom

By measuring more than just weight you can
maintain patient motivation Eg Patient started
exercise- puts on muscle, loses fat. Muscle is
heavier than fat perhaps no weight loss

• Pharmacist decision if Xenical suitable

• Ask pharmacist if vitamin supplement is needed

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6. Lifeweight Program
Patient Record Form 1st Visit (bottom 1st
page)This section initially set by pharmacist

• Weight loss targets need to be modest. Need to
  maintain patient motivation

• Exercise goals will depend on patient history.
  This patient has not done exercise in 4 year

• Set goal weight but do not fix time. Re-adjust
  targets each week

Record what resources given to patient

• Each pharmacy will have their own system. I
  recommend Pharmacy Assistant takes measurements
  and Pharmacist set goals initially

• Lifeweight contains Appointment Cards to motivate
  patients to keep coming back

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What is in Lifeweight Kit? (version 1 June 04)
6. Lifeweight Program
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Are You ready?
6. Lifeweight Program

• Pharmacy can become a Weight Loss destination
• Think of providing solutions - not selling
  product
• Increased personal satisfaction with role
• Has your pharmacy ordered Lifeweight? (contact
  AIPM)
• Delivery date mid-July
• Have a pharmacy policy on how to inform patients
  that your pharmacy will be starting a weight loss
  program in mid-July

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Thank You
6. Lifeweight Program