Plymouth Pharmacy Inhaler Use Review Pilot March 2018

Transcription

1 Plymouth Pharmacy Inhaler Use Review Pilot March 2018 Tony Perkins Lead respiratory pharmacist Livewell SW Training session location; conference room Boringdon Golf Plympton club (no access to sporting facilities) This meeting is supported by Chiesi Limited, GlaxoSmithKline UK and Teva UK Limited through provision of an exhibition stand. Please note that these companies will have no input into the design or content of the event or agenda.

2 Pharmacy Inhaler Use Review This service is A pilot Locally commissioned To review inhaler technique To review medicines adherence and waste This service is not A clinical review An Asthma review A COPD review

3 Pharmacy Inhaler Use Review In order to support patients to get the maximal benefit from their inhalers, across Plymouth, community pharmacies are able to offer an inhaler use review in the pharmacy. In Plymouth, prescribing data indicates we supply very low numbers of spacers. Plymouth is in the lowest 25% of national prescribing for spacers and our prescribing spend on inhaled steroids is 11% higher than expected compared to national data. Low spacer data from Presquipp CCG_Priorities_Report_201708_aug17data_v3 (1).xlsx Epact data Jul Aug 2017 Inhaled steroid Ratio Act Cost % vs national

4 Western Locality Devon CCG Spacers per 1000 pts Top quartile > 3.28 Bottom Quartile = <2.52 NEW Devon = 1.86 Devon+Cornwall = 2.02

5 Inhalers and Spacers local resources

6 Adherence BTS It is estimated that between a third and a half of all medicines prescribed for longterm conditions are not taken as recommended, and evidence in asthma confirms widespread non-adherence to regular preventer medication, that increases over time. Poor adherence should always be considered when there is a failure to control asthma symptoms. Non-adherence to medication use may be intentional and/or unintentional and may be understood as the result of the interaction of perceptual factors (for example, beliefs about illness and treatment) and practical factors (forgetfulness, capacity, resources and opportunity).

7 Smoking Cessation 2.1 Epidemiology of smoking. Tobacco smoking remains the single greatest cause of preventable illness and early death in England, accounting for 79,100 deaths among adults aged 35 and over in 2011 Quality statement 1: Identifying people who smoke People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop. Quality statement 2: Referral to smoking cessation services People who smoke are offered a referral to an evidencebased smoking cessation service.

8 Smoking Cessation Quality statement 3: Behavioural support with pharmacotherapy People who smoke are offered behavioural support with pharmacotherapy by an evidencebased smoking cessation service. Quality statement 4: Pharmacotherapy People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course. People who smoke are more likely to stop smoking if they are offered a combination of interventions, with combined behavioural support and pharmacotherapy the most likely to be successful. Pharmacotherapy interventions act as an aid to help people to stop smoking, increasing the chances of success. It is therefore important that people receive behavioural support and the full course of their chosen pharmacotherapy in line with recommendation..

9 VBA In relation to smoking cessation healthcare professionals should offer Very Brief Advice (VBA): Ask individuals about their smoking and whether they wish to stop whenever there is an appropriate opportunity to do so Advise on how to stop smoking Act by offering those who wish to tackle their tobacco addiction a prescription for nicotine replacement therapy and providing information, signposting or referring individuals to the support they need.

10 The Pilot Read the service spec for full details! It s a pilot time limited Agreed with LPC Only in agreed pharmacies location, capacity to deliver (LPC/Area Manager)

11 The Pilot 1. Pharmacist or Technician who have attended training event There is Payment for the scheme for the pilot A spacer can be supplied if inhaler technique poor - spacer at cost price + dispensing fee InChecks please use these. These have previously been supplied to all Western locality pharmacies. (2014)

12 The Pilot 2. Adults only 18 or over. Particularly useful for high dose ICS - MDI In line with the national Medicines Use Review scheme, this service can only be offered to patients who have been using the pharmacy for the dispensing of their prescriptions for the previous three months

13 The Pilot 3. Patient consent form Patients are not obliged to partake in the service Each patient can be reviewed a maximum of once in this pilot. Patients can only be reviewed with their consent once they have completed a consent form Retain patient consent form as per MUR service specification / SOPs.

14 The pilot 4. Patient feedback survey monkey Please try to encourage patients to complete. 1. How satisfied were you with the inhaler review in the pharmacy? 2. How did the inhaler review affect your understanding of your inhalers 3. 1 month after the inhaler review in the pharmacy, are your respiratory symptoms: 4. Would you agree to have a more detailed respiratory review in the pharmacy in future for example discussing symptom severity and changes to your prescribed inhalers? 5. Did the inhaler review change your smoking behaviour? This has been modified slightly vs spec Would pharmacy be ok with printing some paper copies for patients to return for non internet patients? 6. Were you supplied a spacer by the pharmacy through this service. (A spacer is plastic tube for your metered dose inhaler) 7. Only answer if yes to Q6. If you were supplied a spacer through the pharmacy service are you still using the spacer with your preventer inhalers?

15 The review process Please look at the full spec yourselves

16 Inhaler mishandling remains common in real life and is associated with reduced disease control (Melani et al 2011) We have a total of 2288 records of inhaler technique. Critical mistakes were widely distributed among users of all the inhalers, ranging from 12% for MDIs, 35% for Diskus and HandiHaler and 44% for Turbuhaler. Independently of the inhaler, we found the strongest association between inhaler misuse and older age (p = 0.008), lower schooling (p = 0.001) and lack of instruction received for inhaler technique by health caregivers (p < 0.001). Inhaler misuse was associated with increased risk of hospitalization (p = 0.001), emergency room visits (p < 0.001), courses of oral steroids (p < 0.001) and antimicrobials (p < 0.001) and poor disease control evaluated as an ACT score for the asthmatics (p < ) and the whole population (p < ). We conclude that inhaler mishandling continues to be common in experienced outpatients referring to chest clinics and associated with increased unscheduled health-care resource use and poor clinical control. Instruction by health caregivers is the only modifiable factor useful for reducing inhaler mishandling