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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR25

A survey to assess patient, GP and pharmacist attitudes towards medicines management in people with Parkinson's disease undertaken in the community pharmacy setting (survey pilot: phase 1)

By Mike Gray, Mary Baker*, Manjit Aujla&134;, Ziba Rajaei-Dehkordi and Paramjit Sandhu

Introduction Parkinson's disease (PD) is a progressively disabling neurological condition often resulting in a complex treatment regimen.1,2 There is a recognised need for systematic monitoring of the drug therapy, both for side effects and to confirm that the prescribed therapy is continually optimised to achieve the desired outcomes.3-5 To date there is no mechanism for community pharmacists or GPs to identify sub-optimally controlled patients for active review.
The community pharmacist is ideally situated to take on such a role in the management of people with PD. Surveys were utilised to gather descriptive baseline information to facilitate the development of a unique PD monitoring programme.
Survey questionnaires were designed to identify: the pharmaceutical care needs of people with PD; the level of intervention GPs would wish to see from pharmacists; the level of service pharmacists would be willing and able to provide; the level of support from GPs and people with PD for pharmacists undertaking such a role; and how the pharmacists should undertake the medicines management of people with PD.

Method An expert panel was established in collaboration with the Parkinson's Disease Society of the United Kingdom to develop a tool for monitoring PD patients in the community pharmacy setting.
One hundred and ten community pharmacy members of Pharmacy Alliance were invited to complete a pharmacist survey and distribute specific surveys to their local GP and people with PD. All completed survey forms were returned direct to Pharmacy Alliance for data analysis. No identifiers were used on the GP or patient surveys to ensure confidentiality.

Focal points

  • Parkinson's disease is a disabling neurological condition resulting in a complex drug treatment regimen
  • Community pharmacists are ideally placed to monitor this drug therapy, for effectiveness and possible adverse events
  • Descriptive baseline information was collected by surveying the participating groups, ie, patients, GPs and pharmacists, to assess attitudes towards medicines management
  • The responses of the participants have given a mandate for the development of a medicines management programme in parkinson's disease
  • A programme has been developed (phase 2) to deliver this service to patients (awaiting MREC approval)

Results Of 161 patients who completed questionnaires, 68.5 per cent supported having pharmacists involved in the drug management of PD, including being questioned on symptoms and side effects. Overall, 79 per cent felt that their pharmacist should take on an extended role and provide enhanced services in the drug management of PD. Forty per cent of patients did not visit the community pharmacy and therefore inclusion of the carer in the process is crucial.
Of 51 GPs who completed questionnaires, 92 per cent indicated that they are supportive of the pharmacist providing advice and 76 per cent on monitoring patients. Fifty-six per cent also stated that they would be interested in attending joint training at the next stage of the programme. Overall, 70 per cent of GPs were very supportive of the pharmacist taking on this enhanced role with a further 26 per cent unsure; only 4 per cent did not feel that it was appropriate.
Of 67 pharmacists who completed questionnaires, all but one were willing to provide this enhanced role with dedicated training and support.
The overall results indicate that patients would welcome advice on certain symptoms and aspects of their treatment; there is support for pharmacists undertaking an integral role in the multidisciplinary health care team for the management of PD, and pharmacists are interested in this extended role.

Discussion The survey results have given a mandate for the production of a community pharmacy-based programme that provides a medicine management service to people with PD and their carers. The programme will be delivered in collaboration with local GPs and will focus on quality of life indicators rather than the more traditional outcome measures for PD. The service will be delivered by using patient/carer completed questionnaires.
The programme is currently awaiting Multicentre Research Ethics Committees approval and is planned for delivery through Pharmacy Alliance members later this year.

Pharmacy Alliance; *Parkinson's Disease Society of the UK; &134;DuPont Pharma

References

1. New drugs in the treatment of Parkinson's disease. MeReC 1999;10:37-40.
2. Whetton-Goldstein K, Solan F, Kulas E, Custon T, Schenkman M. The burden of Parkinson's disease on society, family, and the individual. J Am Geriat Soc 1997;45:844-9.
3. Bhatia K et al. Guidelines for the management of Parkinson's disease. The Parkinson's disease consensus working group. Hosp Med 1998;59:469-80.0
4. McMahon DG. Thomas S. Practical approach to quality of life in Parkinson's disease. J Neurol Suppl 1 1998;245:S19-22.
5. Thomas S, MacMahon D, Henry S. Moving and shaping- the future, commissioning service for people with Parkinson's disease. Parkinson's Disease Society UK, primary care task force, 1999.