The Pharmaceutical Journal
Vol 268 No 7198 p683-685
18 May 2002

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Letters to the Editor

Community pharmacy

Why we need to improve support for patients on oxygen

From Mr M. Bennett, MRPharmS

I was pleased to read the recommendations made by Guy Thompson in his article (PDF* 70K) "Prescribing of long-term oxygen therapy — striking a balance?" (PJ, 4 May, p619). However, I believe that these need to go further and encompass the key role that community pharmacists can play in supporting oxygen patients and how this role can be developed.

Following the review of oxygen therapy instituted by the NHS Executive (PJ, 1 April 2000, p500), a group of pharmacists in Sheffield undertook a survey of pharmacists and patients. Because of the need to obtain data quickly in order to respond to the review, the sample was small (10 community pharmacists, 26 patients, and an analysis of prescriptions for 39 patients).

The survey showed that:

• 89 per cent of patients were over 60 years old (mean age=71)
• 62 per cent of patients received additional services (eg, liaising with the surgery about prescriptions, collecting prescriptions, delivery of other medicines, supplying medicines in special containers to aid compliance and reviewing medication needs)
• Over 80 per cent rated the service as "excellent"
• For 17 per cent of the respondents, it appeared to be more economic if a concentrator had been installed
• 35 per cent of patients were using oxygen when away from their home
• 83 per cent were taking three or more medicines
• 89 per cent had initially been prescribed oxygen through a hospital

Overall the survey showed the important role currently played by community pharmacists and highlighted how this could be enhanced under a system in which the initial prescribing was undertaken by a respiratory consultant with the community pharmacist becoming a dependent prescriber, adjusting the dose and type of equipment to match clinical needs, social requirements and prescribing costs, alongside regular feedback to the initial prescriber.

The evidence we obtained illustrated that the current service provided by community pharmacists is much appreciated by patients. However, there is a need to build on this foundation to provide a pharmaceutical care package at a new level. Currently this is limited by:

• The contractual agreement with primary care trusts
• The inability (and financial disincentive) for pharmacists to institute a move from cylinders to concentrators where this is acceptable to the patient and would make economic sense
• The limitations of the prescribable equipment, as illustrated by Mr Thompson
• The lack of any input from prescribers — it is most unusual to be given any details of flow rate or length of time to be administered on form FP10

Finally, may I make a plea to look at the overall package of care? It is easy, when viewing the cost of the current service, to see potential savings but to miss potential additional costs. The delivery fees came from the global sum for pharmacy. Currently they help to support many additional services provided alongside oxygen delivery. Community pharmacies are under severe financial pressure and the removal of any sources of funding can have major implications on the viability of pharmacy services and in some cases the whole pharmacy.

Martin Bennett
Sheffield

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