I’ve returned from a Saturday morning in community pharmacy practice and am reflecting on the number of patients I saw with asthma. I checked one woman’s inhaler technique, spoke to a teenager about avoiding oral thrush post inhaled steroid use, counselled a 10-year old boy with his father about his new inhaler and spacer device and issued an emergency supply for salbutamol. There is no doubt that I made a difference to the people I served.
The evidence for the contribution community pharmacy can make is compelling. We have seen various pilots and studies demonstrate that pharmacy teams are effective in improving inhaler technique1, improving asthma control and symptoms2, carrying out asthma reviews3 and reducing admissions4. I’ve helped many patients understand why they have been prescribed their inhalers, how they work, how to use them effectively and what the medicine does to help.
Aside from improving outcomes, we also help to reduce waste. Asking one patient with an exacerbation to show me how she used her device, she did not close her lips around the mouthpiece, did not inhale and breathed out a cloud of propellant and drug as she used it. Additionally, every time she used her inhaler, she ‘tested’ it once into the air; she was essentially getting through at least twice the amount she needed to.
Community pharmacy in England has asthma support embedded in its NHS contractual framework. The NHS Medicines Use Review (MUR) service can be offered by all pharmacies and enables pharmacies to have a semi-structured discussion with patients to optimise their use of medicines. Similarly, the NHS New Medicine Service (NMS) enables us to discuss medicines with patients who have been newly prescribed a medicine for a long-term condition and then to follow up a further two times to answer any questions. Both services are in place to optimise the outcomes an individual has from their medicines, improve their adherence to treatment and identify any issues they may have. Asthma is a target condition for both services. Last year, the Quality Payment Scheme was introduced with a financial incentive for us to show evidence that asthma patients, dispensed more than six short acting bronchodilator inhalers without any corticosteroid inhaler within a six-month period, were referred to an appropriate health care professional for an asthma review.
In the last decade, community pharmacy’s role has become further established in asthma management but there’s so much more we can do.
Asthma patients usually engage monthly with a pharmacy to receive their dispensed medicine and so we are well placed to intervene. Our support extends beyond informal and formal asthma medicine advice; we also support patients with asthma with help to stop smoking, administer their flu vaccination, support self-care and issue urgent supplies.
The GP service is groaning under the strain of demand; now is the time for an enhanced role for pharmacy in asthma management.
Deborah Evans is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy and the industry. Go to pharmacycomplete.org or email Deborah@pharmacycomplete.org
1 Local Professional Network for NHS South Yorkshire and Bassetlaw September 2012 to March 2013
2 South Central Region community pharmacies April 2011 to June 2012
3 Leicester City community pharmacy teams
4 Isle of Wight Primary Care Trust and community pharmacies 2010