Posted by: Sean Quay9 MAY 2018
Some days I feel as though we pharmacists tend to spend most of our time checking over other people’s work, rather than carrying out more patient-facing clinical activities. This is not to say that accuracy checking dispensed items or comparing prescriptions against formulary guidelines are not important, in fact quite the contrary. However, it is easy for us to underestimate the true impact of our day-to-day duties if we do not come across any meaningful interventions.
In light of the changing landscape of pharmacy, such as the introduction of quality payments schemes and technological advancements, pharmacy services are being seen as an avenue for us to make an even bigger contribution to patient outcomes. Consequently, people in the profession are forced to be more creative and develop innovative services to meet the growing demands of patients on top of supplementing income loss due to funding cuts. So the big question is, what are the newest pharmacy services that have emerged in recent years?
With an ageing population here in the UK, the management of chronic diseases has long become a growing strain so pharmacists are constantly looking at ways to innovate the way we manage chronic treatments. That being said, innovative pharmacy services do not necessarily require reinventing the wheel. The Leicestershire Pharmacy Federation recently started a collaboration with secondary care to develop a medicines adherence programme. An enhanced Medicines Use Review (MUR) if you like, for people with Inflammatory Bowel Disease (IBD). One of the greatest expense contributors in the treatment of patients with Crohn’s Disease or ulcerative colitis is the disease progression following flare-ups which require emergency interventions from secondary care. These flare-ups are usually due to medicine non-adherence which this service aims to reduce. The programme builds on the basic principles of the MUR framework with pharmacists initially supporting the patient in gaining a deeper understanding of the condition and how to optimise their medicines regime. Patients are then enrolled onto a support program with online assistance and 24-hour care line access to specialist IBD and Crohn’s nurses for up to twelve months. As we all know, adherence is a major issue not only for people with IBD but almost all patients with long-term conditions so this is definitely a key area for community pharmacists to add value to patient care and integrate our profession into a multidisciplinary approach to good clinical practice.
Speaking of chronic conditions, warfarin clinics are gaining more and more traction these days. This service of monitoring patient’s INR and adjusting warfarin doses by pharmacists has been in motion for several years, being carried out by the Day Lewis pharmacy, commissioned by hospitals in South London. Researches are now seeing more and more evidence of enhanced patient outcomes and satisfaction as a result of this pharmacy-led service. Tests are carried out on the spot in the pharmacy. Patients are able to wait for the results and be advised of dose adjustments if necessary. This service also includes household visits for housebound patients. With growing evidence in support of its effectiveness, this is a service bound to grow exponentially in the near future.
Sore throat testing
Another pharmacy service which has been piloted by a number of independent pharmacies and pharmacy chains is the sore throat test. Each year, more than a million patients visit their doctors because of sore throats which may or may not be caused by bacterial infections. In an effort to reduce the burden on GPs and contribute towards antimicrobial stewardship, pharmacists are now carrying out throat swab tests for Streptococcus A, a common bacteria associated with sore throats. Patients are then prescribed antibiotics if appropriate. It also allows pharmacists a chance to identify cases that require further medical attention such as laryngitis, tonsillitis or glandular fever. This sore throat scheme is one of the eight schemes being endorsed by the NHS Innovation Accelerator, a think tank that supports the expansion of high-impact innovations for patients. While there are many obvious benefits to the service, such as helping avoid any unnecessary visits to the GP and inappropriate antibiotic prescribing, it has received mixed reviews as there is a lack of cost-effectiveness analyses and some say that this service does not really go beyond normal care.
One of the latest topics to hit the pharmacy scene is the change in licensing of sildenafil from a POM to P medicine. Prior to this however, Boots introduced an online erectile dysfunction (ED) clinic available to men over the age of 18. An online consultation helps collect information about the patient’s condition and blood pressure status. The Boots consultation team led by pharmacy independent prescribers and GPs will then review the consultation and prescribe the appropriate ED medicine which can be bought online or in store.
With the constant advancements in telepharmacy and pharmacogenetics, the scope for pharmacy should see further expansion in years to come.