A pilot project in which community pharmacists identified adults with poorly controlled asthma and facilitated appropriate action was the runner-up in the community pharmacy section.
The entry came from the Pharmacy Alliance division of Unichem Ltd. The project had been carried out in 30 Unichem and Moss pharmacies across Britain in agreement with local general medical practitioners and with central administration by Pharmacy Alliance. It was supported by an educational grant from Glaxo Wellcome.
Asthma was chosen for the project because studies had suggested that almost half of all asthma patients had suboptimal control and about half of those who used metered dose inhalers received inadequate doses because of poor technique. The programme aimed to improve patients' understanding of and concordance with prescribed treatment and to help identify those who required a review of their therapy.
Pharmacy Alliance developed a structured framework to ensure a consistent approach to patient intervention monitoring, GP referral and follow-up. Of 100 pharmacists given training, 30 went on to the patient recruitment stage.
The programme used the current British Guidelines for Asthma Management to identify suboptimal control. When suitable patients were identified, their poor symptom control was managed either by counselling and the provision of information within the pharmacy or by referral to the GP.
The pharmacists found poor inhaler technique in 44 per cent of patients. Two-thirds improved after training by the pharmacist and one-third needed referral. Pharmacists made 82 referrals to GPs, who accepted 74 recommendations. All patients were followed up after one month.
Patient outcomes were measured on a validated 12-point scale indicating severity of symptoms. Those patients who went through intervention and follow-up had an average score before intervention of 7.0. On follow-up, their average score had been reduced to 4.3.
The outcome of GP referral was measured by changes in therapy. The changes made were: addition of corticosteroid inhaler, 24 per cent; increase in strength or dose of steroid inhaler, 18 per cent; change in device, 26 per cent; addition of spacer, 20 per cent; addition of long-acting reliever, 12 per cent.
On completion of the programme, each patient was sent a patient satisfaction questionnaire. Satisfaction was found to be high, with 85 per cent of patients rating the service "excellent" and 89 per cent finding the written materials "useful" or "very useful".
The programme is now being rewritten to take account of feedback from the pharmacist participants and recent recommendations of a working party from the Central Health Outcomes Unit. Pharmacy Alliance intends to extend the programme to include a further 70 pharmacies once future funding has been confirmed.