This project aims to support patients to gain the most benefit from their inhaled corticosteroids. Through consultation with community pharmacists and pharmacy technicians patients receive:
This project has run in the western locality of NEW Devon CCG. In this locality volume of inhaled steroid prescribing is 11% higher than average. Although NEW Devon CCG prescribe high dose ICS below national average, the prescribing of high dose ICS is approximately double that prescribed by our neighbour CCG South Devon and Torbay
The project has run in Plymouth since March 2018 and 135 consultations have been recorded to date (25.7.18). All consultations are recorded on pharmoutcomes and this data can be reviewed.
The project originated from an evaluation of PrescQIPP data which showed spacer prescribing in the CCG was very low (bottom quartile of national). The medicines optimisation team in collaboration with Plymouth county council, the LPC, and local specialist respiratory pharmacist agreed a service specification for inhaler reviews in community pharmacy.
A bespoke pharmoutcomes template was created to align to the service specification and collect details of pharmacy activity. This data has been used to understand which pharmacies have recorded the most and least consultations and thus target low performing pharmacies to offer support and share success.
Since launch month on month activity has increased and 54 consultations were recorded in July, 135 consultations have been recorded in total.
A patient who cannot use, or does not use their preventer medication would stand to benefit the most from this service. Patients can receive inhaler technique advice and a spacer without having to consult with their GP practice, hence there is a secondary benefit to primary care workload. 69% of patients were assessed as having poor or fair inhaler technique with and MDI and 34% of patients have been provided with a spacer.
This project has identified 10% of patients have ordered more inhalers than expected, if over ordering reduces there is a benefit to the CCG in terms of reduced medicines waste. 18% of patients have been given a leaflet on medication waste.
Patients using inhalers who currently smoke, (22% in this sample) will benefit following an offer of smoking cessation support. Smoking is the leading cause of preventable death in the UK according to NICE and pharmacies are well placed to offer or signpost to local smoking cessation services.
Patients with low medication adherence (a major risk for preventable asthma death) receive advice regarding the importance of regular inhaled steroid use and where patients are concerned about side effects such as oral thrush advice is given on mouth rinsing.
Pharmacy technicians are a beneficiary as this is a service which they can deliver and demonstrates a wider use of skill mix beyond medication dispensing.
Of 135 patients:
