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Community pharmacy screening project helps identify patients with COPD and emphysema

Screening model failed to find patients with lung cancer but helped identify other serious respiratory diseases

Community pharmacists taking part in an innovative lung cancer screening project have successfully identified patients who unknowingly had moderate or severe emphysema or chronic obstructive pulmonary disease (COPD), although they failed to find any patients with lung cancer, according to results from the second phase of the trial.

The initiative was developed in South and West London and was the first of its kind, enabling community pharmacists to refer patients direct to hospital, bypassing GPs.

The screening project was originally run as a three-month pilot in 2011 involving 18 pharmacies in Wandsworth and Croydon. The second phase of the scheme involved 43 pharmacies recruited from a wider area expanded to include Sutton and Merton.

As part of the initiative, counter staff offered a pharmacist consultation to any customer aged over 50 years who had a history of smoking, who visited the pharmacy to buy cough medicines or nicotine replacement therapy, or who was collecting a prescription for a respiratory complaint or seeking advice about a respiratory condition.

Pharmacists were able to refer patients suspected of lung cancer direct to a consultant-led hospital respiratory clinic during the project, the second phase of which ran for six months ending in March 2013.

Some 47 patients accepted a referral to the clinic. Of these, 66 per cent had a “significant” diagnosis, including 30 per cent who were found to have moderate to severe emphysema or COPD.

Patients found it easier to talk to their pharmacist about lung cancer risks

The results of the second phase “demonstrated very positive and promising results” about the acceptability of pharmacists directly referring to secondary care, according to the evaluation. Patients said it was easier to talk to a pharmacist than their GP about the risks of lung cancer and GPs welcomed the speed of chest clinic referral, the evaluation noted.

The future of the referral scheme is undecided following the reorganisation of the NHS. However, according to David Tamby-Rajah, community pharmacy lead for NHS South West London, the model could contribute to NHS England’s pharmacy call to action consultation because it illustrates “transformational” practice.

He told PJ Online: “In terms of professional support for the project, it brought in the College of Pharmacy Practice, the local pharmaceutical committees and the then primary care trusts and acute trusts working with the network of community pharmacists.

“During the course of the project it was clear that some of the pharmacists had identified COPD. However, we need to see the outcome of the evaluation and further evidence to see how best it can be taken forward.”

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11135044

Readers' comments (5)

  • Hmmmm interesting. Please can you direct me to where this project is published? I'd be interested to understand how pharmacists can identify COPD. Is this an actual diagnosis or an inevitable statistical consequence of over referral. For this reason I'd also be interested in any feedback from the consultants.

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  • Of the 47 people, how many were already diagnosed as having mild/moderate COPD or what co-morbidities? Of the 47 who attended clinic suspected of having lung cancer, how many HAD lung cancer as surely this is the outcome being assessd (line 17 )? 


    We know that patients find pharmacists often easier to speak to I do not see this as new 'positive and promising' information from this study. I disagree entirely that this is transformational, being told you may be at risk of cancer/COPD due to smoking or coughing is well publicised and could be 'identified' at your local newsagent when picking up your Benson and Hedges. 

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  • Hi Rachel and Emer,


    Thank you for your comments. We understand that none of the 47 patients who accepted the referral went on to be diagnosed with lung cancer.


    We're trying to get hold of the project lead to answer your other questions, including whether the findings have been published (as far as we know, the findings aren't yet published).


    I will let you know when we hear from her.


    Harriet

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  • Hello again,


    The project lead has responded to some of your queries (see below) and has said she will answer the remaining questions when she can access the data. I hope this helps.


    Harriet




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    Q1) The study has not been published yet; we are
    currently presenting the findings at various conferences.   It is intended that the final scientific paper/report
    will be published in early summer (2014).   As
    part of the project, participating pharmacies were provided with training which
    included identifying possible symptoms of suspected COPD and suspected lung
    cancer.   Pharmacists were not making
    diagnosis of COPD but based on a presentation of a defined list of symptoms and
    meeting defined referral criteria (aged 50 and over, smoking history and cough
    for 3 weeks or more), pharmacists referred customers with suspected symptoms to
    secondary care for a chest X-ray.   Once a
    patient attended secondary care, they were given a chest X-ray and spirometry
    and any additional investigations needed and a diagnosis given (if
    appropriate).   We had full support of the
    respiratory consultants at the participating chest clinics.

    - Zoe Keddie, NHS South London Commissioning Support Unit

     

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  • We have some further details from project lead Zoe Keddie, of NHS South London CSU:


    "Of the 47 [people referred], a new diagnosis of COPD was made in 14 patients (30%). This is a new diagnosis and therefore none of these were already diagnosed with COPD. None of these had any specific comorbidities of note, however 17 other patients (36%) were given another significant diagnosis other than COPD, such as pneumonia, asthma, acute bronchitis or cardiac failure.
     
    "In regard to the newsagent picking up COPD, this is an interesting idea; however the point we would make is that customers in a pharmacy are seeking help (but not from their GP), whereas the customers buying cigarettes would be a much harder population to target — but an important one nonetheless. Being told you are at risk may be well publicised amongst healthcare professionals, but not so well amongst the general population as evidenced by the high numbers who present with advanced disease.
     
    "Regarding false positive results [a question raised on Twitter] — this is difficult to say as COPD is a clinical diagnosis and these 14 patients fitted the criteria (spirometric and history); however only time will tell if they respond to treatment. They were all referred back to GP or secondary care chest clinic. Perhaps reviewing patients records a year later will allow us to find the number of false positives."


    Matthew Wright
    PJ Online

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Supplementary images

  • Colour enhanced chest x-ray of severe emphysema

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