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Community pharmacy

Pharmacists to refer patients for chest X-rays in research pilot

The X-ray referral scheme in Carmarthenshire is the first time that community pharmacists in Wales have been involved in a direct referral scheme for early lung cancer.

Community pharmacists in Wales will able to directly refer patients for a chest X-ray as part of a study to help increase the number of people identified with early lung cancer.

The ‘Pharmacy referral for lung cancer symptoms’ (PLUS) study, which involves 16 of the 17 community pharmacies in Llanelli, Carmarthenshire, as well as consultant physicians at Llanelli’s Prince Philip Hospital, is expected to start before the end of June 2019, according to the Hywel Dda University Health Board’s annual plan.

Community Pharmacy Wales has said this is thought to be the first time that community pharmacists in Wales have been involved in a direct referral scheme for early lung cancer.

Gareth Collier, respiratory consultant at Prince Philip Hospital and lead researcher on the study, told The Pharmaceutical Journal that he wants to “increase the numbers of patients we diagnose with lung cancer at an early stage” as “stage I and II patients have more chance of [being cured]”.

“Studies have suggested late-stage presentation [of lung cancer] is associated with a low awareness of symptoms, as well as difficulty in accessing primary care and subsequent investigations,” he said.

“Primary care doctors are often concerned awareness that campaigns will overload their already stretched services.

“The PLUS study combines the development of a specific awareness campaign, developed with the local population to increase awareness, with increased ease of access to healthcare advice and initial investigation by using our very knowledgeable and accessible community pharmacy resource,” he said, adding that he hopes “this combination will result in a greater proportion of patients diagnosed at an early stage, while at the same time not overloading general practice”.

The study’s website says that the research results will provide an understanding of which services can be developed to “help patients get the most appropriate treatment for symptoms and will add to an area of research that is improving earlier diagnosis”.

The initiative is the latest example of community pharmacists being given the power to directly refer patients for X-ray or specialist clinics to promote the early detection of respiratory diseases, including lung cancer.

One example is a pharmacy-led health service pilot in Doncaster that ran between September 2015 and April 2016 — the ‘Accelerate, coordinate, evaluate (ACE) programme’ — involving community pharmacists who were able to directly refer patients whom they suspected of having lung cancer for an X-ray. 

Over the course of the pilot, 16 patients were identified as potentially being at risk of lung cancer and were assessed by participating community pharmacists. Some ten patients were referred for a chest X-ray; one patient was then diagnosed with a stable lung condition, but no lung cancer was diagnosed in any of the patients.

According to the ACE programme’s evaluation report, co-published by NHS England and charities Cancer Research UK and Macmillan Cancer Support in June 2017, the scheme was decommissioned by the NHS Doncaster Clinical Commissioning Group after local GPs expressed concern about the pharmacists’ ability to make appropriate referrals.

The evaluation of the pilot in Doncaster also notes a similar referral pilot, which ran for 12 weeks in 2011, in which community pharmacists in south west London referred 47 patients with suspected lung cancer who were smokers with persistent cough to a consultant-led hospital respiratory clinic. 

None of the referred patients were found to have lung cancer; however, 14 were diagnosed with COPD.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206456

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