Medicines Management - Pharmacy and ... - Health in Wales

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Practice examples Identifying sub-optimal asthma control (Tier 2) – National Lloyd’s pharmacy, in partnership with Asthma UK, co-ordinated a targeted approach in which their pharmacists identified people whose asthma was less well controlled and offered them a Medicines Use Review. The results from 200 pharmacies demonstrated that: ◗ Over half were using their reliever inhaler too frequently. ◗ Just over two thirds of the patients whose asthma was sub-optimally controlled were referred to their GP where changes to prescribed treatment were made in almost two thirds of these cases. Contact: Clare Kerr Clare.Kerr@lloydspharmacy.co.uk Patient education in COPD and other chronic conditions (Tier 1/2/3) – Torfaen Pharmacists working in Torfaen LHB have delivered educational sessions on medication at Structured Education Course Groups facilitated by the Long Term Conditions Specialist Nurses. These sessions have included COPD, diabetes, the cardiac exercise group and the stroke rehabilitation group. The sessions were well received by patients as they allowed for two way discussions about their disease management, and provided a opportunity for broader discussion about the pharmacy contract, the costs of medicines, branded and generic medicines. Contact: Wendy Tyler-Batt, Torfaen LHB Wendy.TylerBatt@torfaenlhb.wales.nhs.uk 6
Coronary Heart Disease Overview: Wales has 233,000 people with a diagnosis of a heart condition The average community pharmacy in Wales serves 185 people with angina, has 161 people who have had a heart attack and who will be taking prescribed treatment and 57 people with heart failure The published literature includes several trials of community pharmacy-based services which aim to reduce risk factors for CHD There is good evidence that community pharmacy based services result in improved lipid levels and more patients reaching lipid targets There is some evidence that community pharmacy services can improve blood pressure control There is good published evidence that hospital pharmacist involvement in the heart failure team leads to improved outcomes in terms of reduced hospital admissions and reduced bed days as well as improved implementation of evidence based therapy Point of care testing for blood pressure and lipids is increasingly offered in community pharmacies but integration and use of this data within the wider NHS is unclear The Welsh visit to Kaiser Permanente found that pharmacist were providing several services in CHD management including leading clinics to follow the progress of patients with hypertension, initiating cholesterol-lowering medication, adjusting medication doses and ordering laboratory tests, and approving patients repeat medication Problem statement Coronary heart disease (CHD) kills more than 8,600 people in Wales every year. More than 1.4 million people suffer from angina and 22,000 people in Wales have a heart attack annually. Around 2,300 of these deaths are premature, occurring in people under 75. An estimated 32,000 cases of heart failure are diagnosed in Wales each year and 96,000 patients needing ongoing care 10 . 10,400 people each year die from heart failure in England and Wales. Policy context The NHS in Wales has a National Service Framework, ‘Tackling CHD in Wales’ 11 . The key targets for Wales in relation to CHD are: ◗ To reduce CHD mortality in 65-74 year olds from 600 per 100,000 in 2002 to 400 per 100,000 in 2012. ◗ To improve CHD mortality in all groups and at the same time aim for a more rapid improvement in the most deprived groups. ◗ To reduce stroke mortality in 65-74 year olds by 20 per cent by 2012. These figures suggest that there is scope for pharmacists to contribute to CHD management. Summary of published evidence An earlier review of studies published between 1990 and 2001 included four studies of community pharmacy based hyperlipidaemia management (two Random Controlled Trials (RCTs) and two observational studies) 12 that review concluded that “The RCTs provide convincing evidence, supported by the other studies, that community pharmacists have an important role to play in managing lipid levels. Community pharmacists offer the potential to improve the use of the resources invested in and the outcomes of lipid management”. We identified four addtional more recent studies, one of which was the final publication of an RCT included in the original review 13 . There is good evidence from intervention studies in hyperlipidaemia that community pharmacy based services result in more patients reaching their target lipid levels. A recent Scottish study of people with heart failure and their carers found that treatment regimens were reported to be difficult to comply with. Patients thought health professionals provided little support for medication management. Pharmacists were viewed as being a good and accessible source of practical support and were also viewed as knowledgeable about the individual's heart health history. The authors concluded that an “extended role for pharmacists in supporting patients with heart failure should be encouraged”. 14 7
Page 1 and 2: Pharmacy and Integrated Chronic Con
Page 3 and 4: Foreword In Wales, health and socia
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Page 21 and 22: References 1. Welsh Assembly Govern
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