The Pharmaceutical Journal
Vol 268 No 7190 p411-415
23 March 2002

Society summary

Piecing together the jigsaw to achieve the aims of Scotland's pharmacy strategy

Achieving the vision for pharmacy in Scotland set out in the pharmaceutical care strategy for Scotland, "The right medicine", requires all the pieces of the jigsaw to be in place first, according to the chairman of the Royal Pharmaceutical Society in Scotland, Alison Strath, addressing local health care co-operative (LHCC) pharmacists on 16 March.

Speaking in Dunblane, Perthshire, at a weekend conference organised by the Society in Scotland, Miss Strath reinforced the importance of a working infrastructure. The jigsaw pieces included issues centred around pharmacy premises, such as design and accessibility, a more integrated information technology system with connection to the NHSnet, better use of skills and personnel (including empowerment of technicians, group practices and enhanced job satisfaction), and the development of pharmaceutical care and other enhanced services such as pharmacist prescribing.

Ms Strath mentioned the importance of bringing hospital pharmacists into the picture too and the use of inpatients' own medication. What was needed was the belief in a "can-do" culture that could win over colleagues' hearts and minds to embrace change and establish new ways of working.

Addresses by Miss Strath and the Chief Pharmaceutical Officer for Scotland, Bill Scott (see p385), were followed by presentations from four LHCC pharmacists detailing the projects on which they were currently working.

Intervention scheme

Graeme Bryson (prescribing adviser, Ayr, Prestwick and Troon LHCC) described the implementation of a community pharmacy based intervention scheme. Seven interventions were chosen for study: dose optimisation, preparation rationalisation, generic prescribing, inappropriate generic prescribing, therapeutic substitution, treatment rationalisation, and recommendation of new therapies

A three-part form was designed to record interventions. One copy went to the doctor, one went to the LHCC and one was retained in the pharmacy. Since the scheme was rolled out in January 2002, 14 of the 15 pharmacies involved had submitted a total of 90 interventions. The main reasons for interventions have been inappropriate generic prescribing (33 per cent) and dose optimisation (31 per cent). The results would be used in future medicines management initiatives.

Quality

"Developing quality in community pharmacy practice" was the title of a presentation by Helen Lindsay (Glasgow pharmacy audit pharmacist). Ms Lindsay explained that the current project had developed from a 1994 pilot study in Glasgow on professional self audit. On that occasion community pharmacists were invited to look at their dispensing practice in a non-threatening manner and identify where they considered improvements could be made. The first module has now grown to 10, covering a wide range of pharmacy services and contained in a folder entitled "Quality in practice" issued by Greater Glasgow Health Board. The aim of this study was to aid LHCC groups to address clinical governance by facilitating discussion of the results of applying a dispensing self-audit module to their practice, and assessing the extent of improvement after a second self audit. Forty per cent of Glasgow' 214 pharmacies took part and met as LHCC groups to discuss their results and formulate an action plan. The second audit was carried out after six months. Initial results show a positive shift towards more positive answers to the audit questions. In one LHCC group the overall availability of written protocols for various procedures improved from 63 to 85 per cent after reaudit. The audit tool therefore appeared to be an effective tool in achieving significant improvements in clinical governance.

Hypertension

Fiona Reid (pharmacist for hypertension management, Newbyres Medical Group, Gorebridge) described the implementation of a multidisciplinary approach to the management of hypertensive patients in primary care. Ms Reid explained that there had been a change in the guidelines for treatment of hypertension. The blood pressure threshold for treatment of diabetic patients had been reduced from 140/85mmHg to 130/80mmHg and for non diabetic patients from 150/90mmHg to 140/85mmHg. The new guidelines also indicate when aspirin or statins should be used. The study sought to investigate the uptake of the new strategy by identifying the patient population, establishing a pharmacist-led hypertension clinic, setting up a repeat prescription service, to evaluate the clinical impact of the clinic and to gauge patient satisfaction, the latter using a semistructured questionnaire and focus group. In the first cohort of 142 patients a significant improvement in the number of patients meeting target blood pressure and the audit standard before and after the study was archived.

EHC supply

The final presentation, by ROSEMARY JOHNSTON (Fife Primary Care NHS Trust), detailed an investigation into the free supply of emergency hormonal contraception (EHC) in Fife. Members of the local sexual health strategy group had felt that the £19.99 fee for EHC bought in pharmacies might be a barrier in deprived areas. It was decided to copy the Manchester project and supply EHC free through pharmacies as an extension of family planning clinic services. In addition, pharmacists supplied a free pregnancy test after the EHC had been used and free condoms together with counselling as part of the package of measures to deal with rising teenage pregnancy in the area.

The service has been made available to any female who has a menstrual cycle. The patient group direction allowed supply to clients as young as 12 but that no supply had yet been made to clients younger than 14. Although this is permissible under the Children (Scotland) Act 1995, pharmacists need to assess whether the patient is competent to understand the treatment offered.

Approximately 4 per cent of women who asked for EHC in a pharmacy were refused and referred to their GP because more than 72 hours had elapsed since intercourse or they had already used EHC in the current menstrual cycle or they were experiencing vaginal bleeding.

Of 464 women given EHC after condom accidents or unprotected sex, 45 per cent were in the 16–20 age group and 5 per cent were under 16. There was also "a sprinkling of requests" for EHC from women aged over 40 years. The project is ongoing.
— From our Scottish correspondent, Dr Steven Kayne