South Central Respiratory South Central Respiratory ProjectProject

MK ReportMK Report1010thth October 2011 October 2011

Nikki HughesNikki HughesCommunity Pharmacy Lead Community Pharmacy Lead

NHS Milton keynesNHS Milton keynes

What worked well for NHS MK?What worked well for NHS MK?

PreparationPreparation InformationInformationCommunicationCommunication

BackgroundBackground

In MK we prescribe £3m of inhalers In MK we prescribe £3m of inhalers annually (estimate)annually (estimate)

We know that patients do not use inhalers We know that patients do not use inhalers effectively – wasting much of this spendeffectively – wasting much of this spend

This project allowed us to measure the This project allowed us to measure the clinical benefit of the pharmacist clinical benefit of the pharmacist intervention at dispensingintervention at dispensing

Preparation: Preparation: we had already ….we had already ….

Run an audit in hospital COPD clinic - most COPD Run an audit in hospital COPD clinic - most COPD patients did not use their inhalers correctlypatients did not use their inhalers correctly

Audited inhaler technique of local HCPs - only 7% could Audited inhaler technique of local HCPs - only 7% could demonstrate correct technique including correct demonstrate correct technique including correct inspiratory flow rateinspiratory flow rate

Run a local pharmacy project - patients are happy to Run a local pharmacy project - patients are happy to access additional support from their pharmacy access additional support from their pharmacy

Run training events on inhaler technique for pharmacy Run training events on inhaler technique for pharmacy teams, GPs, and nursesteams, GPs, and nurses

Provided In-check dials to all pharmacies and practices Provided In-check dials to all pharmacies and practices in MKin MK

Run a multidisciplinary audit to get pharmacists to check Run a multidisciplinary audit to get pharmacists to check inhaler technique when dispensinginhaler technique when dispensing

Information:Information:

We had not been able to measure the We had not been able to measure the effectiveness of pharmacist interventioneffectiveness of pharmacist intervention

The IoW model used symptom control The IoW model used symptom control tests before & after the intervention to do tests before & after the intervention to do thisthis

ESMAQ reporting tool allowed us to ESMAQ reporting tool allowed us to monitor activity & analyse results monitor activity & analyse results real timereal time

ESMAQ allowed…ESMAQ allowed…

The pharmacists could measure the The pharmacists could measure the impact of their intervention on patient careimpact of their intervention on patient care

The scoring helped patients understand The scoring helped patients understand that better technique made them feel that better technique made them feel betterbetter

The PCT could demonstrate the value of The PCT could demonstrate the value of the service to patient care the service to patient care

Communication:Communication: Real time analysis meant we could influence the Real time analysis meant we could influence the

project whilst still underwayproject whilst still underway Pharmacists could see each other’s activity – Pharmacists could see each other’s activity –

this stimulated healthy competitionthis stimulated healthy competition Open access to results allowed pharmacists to Open access to results allowed pharmacists to

measure themselves against their peersmeasure themselves against their peers I could identify & tailor support for slow adopters I could identify & tailor support for slow adopters I could ask trailblazers for top tips of what I could ask trailblazers for top tips of what

worked for them & share these during projectworked for them & share these during project

Communication contdCommunication contdEarly on the GPs reported that patients were Early on the GPs reported that patients were claiming that they no longer needed to attend claiming that they no longer needed to attend review appointments there as the pharmacist review appointments there as the pharmacist had already reviewed them.had already reviewed them. I could refute the reports as 24% of the patients I could refute the reports as 24% of the patients

pharmacists were accessing had not seen a GP or pharmacists were accessing had not seen a GP or nurse for over 12 months. The project improved the nurse for over 12 months. The project improved the reach of messages to these peoplereach of messages to these people

I could influence pharmacists to remind patients it was I could influence pharmacists to remind patients it was even more important to go for GP reviews even more important to go for GP reviews becausebecause improved technique meant that doses should be improved technique meant that doses should be reviewedreviewed

Now 14 patients have been referred into the service Now 14 patients have been referred into the service by the GP / nurseby the GP / nurse

Communication…..3Communication…..3

Results have demonstrated that Results have demonstrated that 37 37 patients (60%)patients (60%) have improved their have improved their symptom control during the project.symptom control during the project.

Where unexpected results happened Where unexpected results happened (sometimes scores got worse..) I could (sometimes scores got worse..) I could encourage pharmacists to see the bigger encourage pharmacists to see the bigger picture, this was normal & not to give up.picture, this was normal & not to give up.

Communication ….4Communication ….4

Results demonstrated improved recruitment to Results demonstrated improved recruitment to stop smoking supportstop smoking support 28%28% inhaler users were smokers inhaler users were smokers 28%28% of these smokers accepted referral of these smokers accepted referral A further A further 44 patients accepted referral at second patients accepted referral at second

interventionintervention 66 extra 4 week quitters so far extra 4 week quitters so far

Communication…..5Communication…..5Patients love it….Patients love it….

A reluctant recruit saidA reluctant recruit said““I didn’t know that – I have learned something today after I didn’t know that – I have learned something today after all. Thank you”all. Thank you”

Pharmacists love it….Pharmacists love it….“…“…another targeted asthma MUR who was suffering oral another targeted asthma MUR who was suffering oral problems from the preventer inhaler. I suggested using a problems from the preventer inhaler. I suggested using a spacer and some improvements to her technique. She spacer and some improvements to her technique. She was using a reliever 4 - 5 times a week. Now she rarely was using a reliever 4 - 5 times a week. Now she rarely uses her reliever and has no oral symptoms. 4 point uses her reliever and has no oral symptoms. 4 point increase in ACT score!increase in ACT score!

Sometimes you get to make a difference!”Sometimes you get to make a difference!”

And the PCT benefits…?And the PCT benefits…? We have developed patient leaflets to be used to We have developed patient leaflets to be used to

highlight individual advice for patients highlight individual advice for patients We will use the “preparation, information & We will use the “preparation, information &

communication” approach againcommunication” approach again We are looking at offering a similar structured We are looking at offering a similar structured

approach to the other target MUR groups…approach to the other target MUR groups… We are collecting evidence to persuade PCT to We are collecting evidence to persuade PCT to

buy ESMAQ next year ….buy ESMAQ next year …. We will use NMS data (from Pharmabase?) We will use NMS data (from Pharmabase?)

locally to influence changelocally to influence change