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And Breathe…. Educational solutions for the NHS pharmacy workforce. Why are we here?. Burden of asthma. UK has largest prevalence of asthma in the world. There are 4.1 million adults with asthma in the UK and 1.3 million children - PowerPoint PPT Presentation
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Educational solutions for the NHS pharmacy workforce
And Breathe…..
Educational solutions for the NHS pharmacy workforce
Educational solutions for the NHS pharmacy workforce
Why are we here?
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Educational solutions for the NHS pharmacy workforce
Burden of asthma
UK has largest prevalence of asthma in the world.
There are 4.1 million adults with asthma in the UK and 1.3 million children
Three people die each day from asthma, of which most are preventable
75 percent of hospital admissions for asthma are avoidable
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Educational solutions for the NHS pharmacy workforce
Burden of COPD
COPD is a leading cause of mortality and morbidity worldwide and the 5th biggest cause of death in the UK
One person dies from COPD every 20 minutes in England, around 23,000 a year
15 percent of those admitted to hospital with COPD die within three months and around 25 percent die within a year of admission
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Educational solutions for the NHS pharmacy workforce
Financial burden of respiratory disease
NHS spends about £1 billion a year on prescribed respiratory medicines
Cost per item is highest of all BNF categories at over £17 per item on average
Only around 40 percent of asthmatics are compliant with treatment. If this doubled to 80 percent, the NHS could save £90 million per year
COPD is the second most common cause of emergency admission to hospital and one of the most costly inpatient conditions to be treated by the NHS
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Educational solutions for the NHS pharmacy workforce
Pharmacy interventions improve outcomes
Respiratory disease is an area where there is evidence that high quality pharmacy intervention can significantly affect patient outcomes
Recent evidence:
• SIMPLE project
• The inhaler technique improvement project
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Educational solutions for the NHS pharmacy workforce
Learning outcomes
By the end of this session you will be able to:
Describe the differences between asthma and COPD and identify the signs that should alert people to the fact that their condition is not being well controlled
Outline ways to improve outcomes for patients by helping them to take their medicines correctly
Provide lifestyle advice to support people to manage their condition
Identify useful resources available to the public and to healthcare professionals
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Educational solutions for the NHS pharmacy workforce
COPD and asthma: the differences
Small groups
One envelope per group
5 minutes to identify characteristics of each disease
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Educational solutions for the NHS pharmacy workforce
COPD ASTHMA
Airway obstruction Permanently damaged and narrowed
Inflammation causes constriction; usually
reversible
Cough symptoms Chronic cough often with sputum
Irritating cough, often at night
Breathlessness Persistent and progressive VariableSignificant diurnal or day-to-day variability of symptoms Uncommon CommonNight-time symptoms that
keeps patient awake Not common Common but variableMain age group affected
Over 35 years Any ageSmoker or ex-smoker
Nearly always Possibly
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How did you do?
Educational solutions for the NHS pharmacy workforce
Asthma – the facts
Asthma is a chronic lung condition in which the airways are inflamed and narrowed, making it harder to breathe normally
The changes to the airways are fully reversible
Although asthma often runs in families, many people with asthma do not have relatives with the condition. Hay fever and eczema are frequently associated with asthma – either in the person with asthma or in their family
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Educational solutions for the NHS pharmacy workforce
COPD - The facts
COPD comprises a number of respiratory diseases, predominantly chronic bronchitis and emphysema
It is preventable and treatable, characterised by airflow limitation that (unlike asthma) is not fully reversible.
The airflow limitation is usually progressive and not curable
90 percent of cases are caused by cigarette smoking
Although COPD affects the lungs, it also produces significant systemic consequences
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Educational solutions for the NHS pharmacy workforce
SIMPLE
Stop smokingInhaler techniqueMonitor control and adherencePatient education on medicinesLifestyleEducation
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Educational solutions for the NHS pharmacy workforce
Stop Smoking
Stopping smoking has been shown to reduce the rate of decline on lung function so is the key message for all those with asthma or COPD, regardless of their age
NICE PH45 Tobacco Harm Reduction
“This guidance recommends harm reduction as an additional new option particularly for those who are highly dependent on smoking who want to quit, but can’t just stop in one go”
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Educational solutions for the NHS pharmacy workforce
Inhaler technique
Inefficient inhaler technique is a common problem resulting in poor drug delivery, decreased disease control and increased inhaler use
Even with effective technique, maximum lung deposition from MDI is 15 percent
Large volume spacers may be easier to use and they increase deposition to 30 percent
Incorrect use is a huge cost to the NHS
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Educational solutions for the NHS pharmacy workforce
“Can you show me how you use your inhaler?”
75 percent of patients using an inhaler for on average 2-3 years reported they were using their inhaler correctly
What percentage actually were?
10 25 50 75 90
10%
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Educational solutions for the NHS pharmacy workforce
How good is your technique?
Patients’ inhaler technique can be significantly improved by brief instruction given by a trained healthcare professional
What percentage of healthcare professionals who teach use can demonstrate them correctly?
9 29 59 69 79 99
9%
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Educational solutions for the NHS pharmacy workforce
Types of inhaler
How many types of inhaler are on the market?
MDI
• Slow and gentle
DPI
• Fast and forceful
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Educational solutions for the NHS pharmacy workforce
Practical support
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http://www.leicestershospitals.nhs.uk/professionals
Educational solutions for the NHS pharmacy workforce
Which inhaler is best?
As healthcare professionals we consider the evidence and the costs
BUT
To optimise medicines use the key is the patient’s perspective
Getting it right from their point of view can have a big impact on adherence and therefore the health outcomes
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Educational solutions for the NHS pharmacy workforce
Monitoring
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Educational solutions for the NHS pharmacy workforce
Patient education on medicines
Difference between relievers and preventers
Side effects
Use of spacers
Corticosteroids
Oxygen use
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Educational solutions for the NHS pharmacy workforce
Lifestyle
What lifestyle interventions should you be discussing?
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Educational solutions for the NHS pharmacy workforce
Lifestyle interventions
Stop smoking
Weight management
Exercise
Self management plans
Trigger avoidance
Vaccination
Advice on heart disease, anxiety, depression for COPD
Pulmonary rehabilitation
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Educational solutions for the NHS pharmacy workforce
Prevention of exacerbations
Offer annual influenza / pneumococcal vaccination
Give self management advice including use of rescue treatment where appropriate
Optimise bronchodilator therapy with one or more long-acting bronchodilator
Add inhaled corticosteroids (as combination)
Use of breathing techniques
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Educational solutions for the NHS pharmacy workforce
Education
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Educational solutions for the NHS pharmacy workforce
CPPE support
Inhaler technique workshops
Focal point : Asthma
iPDF: New medicines service asthma and COPD
Inhaler technique videos
Coming soon:
Learning@lunch: COPD
Focal Point: COPD
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Educational solutions for the NHS pharmacy workforce
In Summary
Respiratory diseases place a huge burden on the NHS and the wider economy
There is mounting evidence that effective pharmacy-based interventions , particularly involving inhaler technique, can have a large impact on outcomes for both patients and the NHS
Pharmacy technicians are well placed to support people with these long term conditions
SIMPLE!
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