Pharmaceutical care of people with rheumatoid arthritis. Course information. Contents of pack Your pack contains: Pharmaceutical care of people with rheumatoid arthritis course information. Pharmaceutical care of people with rheumatoid arthritis course activities. Pharmaceutical care of people with rheumatoid arthritis course resources. Set of pharmaceutical care needs assessment tools for rheumatoid arthritis (10). Plan & record form. Freepost envelope. CD-ROM Video presentation. Acknowledgements This pack was brought together with the help of Carole Callaghan. Special thanks to Kathryn Wilson and Carolyn Dawson. Disclaimer While every precaution has been taken in the preparation of these materials, neither NES nor external contributors shall have any liability to any person or entity with respect to liability, loss or damage caused or alleged to be caused directly or indirectly by the information therein. CD-ROM The CD-ROM with Carole Callaghan s presentation will work on a PC which runs Windows 98 or later and has: a CD-ROM drive a Windows Media player version 9 or later a soundcard with speakers or headphones a web browser, such as Internet Explorer 5.0 or later, or Netscape Navigator 7 or later. Insert the CD- ROM in your computer and wait a little while. The CD-ROM starts automatically and will show the opening page in the browser window. (You may be prompted to download some additional software.) Click on play to run the presentation. If the CD-ROM doesn t work in autostart mode (or if you want to run it on Apple Macintosh), open the CD- ROM and double-click on the file XXX.htm. 1
Introduction Pharmaceutical care of people with rheumatoid arthritis This course offers Scottish pharmacists training on how they can contribute to the care of people with rheumatoid arthritis as part of their normal working practice by applying the principles of pharmaceutical care for patients with chronic diseases. This invaluable training for community pharmacists will help prepare them for the future and should link with previous NES Core Course materials and any local medication review training. The evening will start with a lecture on rheumatoid arthritis and it s management. This will be delivered by a practitioner with a special interest in chronic pain. This will cover definition, pathophysiology, diagnosis, management and common pharmaceutical care issues. The workshops will take the form of very practical patient assessments followed by group discussion. To help with integrated care this course is of interest to pharmacists working within all care settings. Aim To update pharmacists on the current management of rheumatoid arthritis and explore ways to implement pharmaceutical care for this patient group as part of normal working practice. Objectives At the end of the session pharmacists should be able to: describe the common signs and symptoms associated with rheumatoid arthritis define the current therapeutic management for both the alleviation of symptoms and for modifying disease progression in rheumatoid arthritis identify pharmaceutical care issues and appropriate management solutions when responding to symptoms in patient scenarios explore how to implement the principles of a pharmaceutical care needs assessment tool in practice. 2
Pre-course reading Klareskog L, Catrina AI and Paget S. Rheumatoid arthritis. Lancet 2009; 373: 659 672. www.thelancet.com Scottish Intercollegiate Guidelines Network (SIGN) (2004) Management of Early Rheumatoid Arthritis. Edinburgh, SIGN. www.sign.ac.uk Luqmani R, Hennell S, Estrach C, Birrell F, Bosworth A, Davenport G et al on behalf of the British Society for Rheumatology and British Health Professionals in Rheumatology Standards, Guidelines and Audit Working Group. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Rheumatoid Arthritis (The first 2 years). www.rheumatology.org.uk Luqmani R, Hennell S, Estrach C, Basher D, Birrell F, Bosworth A et al on behalf of the British Society for Rheumatology and British Health Professionals in Rheumatology Standards, Guidelines and Audit Working Group. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the Management of Rheumatoid Arthritis (After the first 2 years). www.rheumatology.org.uk Pharmaceutical care needs assessment (PCNA) tool Aide Memoire for PCNA CPD Plan & Record Form. In addition, it is recommended that you update yourself on the section on NSAIDs and Disease-Modifying Anti-Rheumatic Drugs (DMARDs) 3
in the current BNF, along with any local guidelines that exist within your NHS Board for these agents, before coming along to the course. Background Rheumatoid arthritis (RA) is one of the commonest autoimmune diseases. It is a chronic, progressive, systemic inflammatory disorder affecting the synovial joints and typically producing symmetrical arthritis. If left untreated, it leads to joint destruction, which is responsible for the deformity and disability seen in this disease. The disease therefore exerts a considerable burden on society in terms of direct (e.g. medical care) and indirect costs (e.g. effects on the individuals is the potential loss of social and financial independence). The prevalence of RA is consistent worldwide, affecting about 0.5 1% of the population. Although the disease affects people all over the world, certain populations demonstrate particularly low or high prevalence (inhabitants of sub-saharan Africa and native Americans respectively). As with other autoimmune conditions, women are affected more than men at a ratio of 3:1. The goals of RA management are to relieve pain and inflammation, prevent joint destruction, preserve or improve functional ability, and maintain a patient s normal lifestyle. There has been a major shift in the treatment of RA over the past decade. Traditionally, the therapeutic pyramid was employed, whereby initial treatment was conservative, using non-steroidal antiinflammatory drugs (NSAIDs) for several years and only progressing to disease modifying anti-rheumatic drugs (DMARDs) when the disease was not controlled. This approach has been replaced by early treatment with DMARDs, because there is evidence that most patients develop joint destruction within the first two years of their disease. Implementing the pharmaceutical care needs assessment tool A pharmaceutical care needs assessment tool for rheumatoid arthritis has been developed to help pharmacists apply their learning, develop their assessment skills and help their patients get the most out of their medication and reduce any associated risks. It incorporates a simple assessment and follows the same systematic inquiry 4
as the other chronic condition PCNA tools in the previous NES Core Courses by suggesting questions that will allow you to confirm the person s understanding of their condition and or how their medication works, effectiveness (sub-optimal dose or additional medication required), safety (adverse drug reactions, interactions or toxicity) and intentional or non-intentional non-compliance. As people present with their prescriptions for medication used in the treatment of rheumatoid arthritis, confirm their diagnosis and as part of the normal clinical check and counselling process ask if they would like to answer some more in depth questions about their condition. This will help to ensure that they are getting the best from their medication and that they are not at risk of any adverse effects. You can then work through the assessment tool as a single intervention or it can be completed as the person visits the pharmacy with a repeat prescription over subsequent weeks or months. The assessment tool has been designed with direct patient contact in mind and will help pharmacists to speak with patients in a more systematic and focused way. You can adapt the questions to your own style and the needs of your patients. Use it in conjunction with your computerised pharmacy medication records to identify patients you would like to actively target e.g. people over the age of 65 prescribed regular NSAIDs. The aide memoire suggests ways to optimise information provision and drug treatment by summarising key points to help pharmacists support and advise the patient or carer and suggests when it may be appropriate to refer to their GP or nurse. Using this tool will help you to further develop your patient assessment skills and more therapeutic relationships with your patients and medical and nursing colleagues. 5
Teaching plan Lecture Rheumatoid Arthritis 30 minutes and 10 minutes discussion This talk will cover: definition and pathophysiology diagnosis signs and symptoms guidance on management Comfort break 15 minutes Workshops 60 mins Training groups should be divided into groups of between 12 and 15 participants. One facilitator should be assigned to this group, which will then be further subdivided into smaller groups of three to five. Case 1 & 2: volunteers for each case, one participant chosen to play the patient and one to play the pharmacist who completes the case using the pharmaceutical care needs assessment tool. Remaining participants will observe. The group will identify care issues at the end of the role play (10 minute role play with 5 minutes discussion). Each group should do both cases, if possible. Case 3 & 4 : workshop: the small groups work through these together (10 minutes with 5 minutes discussion). Questions/discussion/answers 10 minutes in large groups. Answers should be provided at the end of the session. Summary 10 minutes CPD-action (recording), evaluation and identification of further training needs. Using the spare assessment tools to explore how to implement the tool in practice. Local pain services and support. Course assessment. 6