| Some 18 pharmacists from three primary care trusts — Brighton and
Hove City, Coventry and St Helens — have now been selected to take
part in the Parkinson’s Partnership Project. The project is being
led by the Task Force on Medicines Partnership (funded by the Government
to support concordance in medicine-taking) and will be evaluated by Oxford
university academics. Success for the initiative could lead to a national
network of community pharmacists specially trained to support patients
with Parkinson’s disease and other conditions. The pharmacists
involved will begin training in a few weeks’ time.
One of the participants, pharmacist John Goes from Coventry, said that
patients with Parkinson’s disease could have problems understanding
their condition and the many changes in medication that could be required. “Sometimes
patients are taking medicines six or seven times a day. Someone has to
help them,” he added.
His PCT co-ordinator Mark Galloway said: “Pharmacists have got
to start thinking outside the box. This is what it takes to form the ‘new
age’ in pharmacy.” He explained that participating pharmacists
would receive a fee per patient with recoverable locum fees for the time
they spend in training.
Service implications
Medicines Partnership head of projects Geraldine Mynors said that this
initiative could have significant implications for the future development
of community pharmacy services. She highlighted some of the medication
problems faced by those with Parkinson’s disease. Medication
regimens are often complex and many of the drugs have unpleasant side
effects, such as dyskinesias, on/off and wearing-off effects. Many
patients with Parkinson’s disease are older, with co-morbidities
and widespread potential for drug interactions. Polypharmacy and poor
compliance are common. In addition, patients lack accessible
and comprehensive information about their medicines.
Difficulties in resolving these problems include limited access to “overstretched” neurology
teams, reduced contact with GPs after initial diagnosis and mobility
problems in travelling to clinics.
She explained that the nominated community pharmacists would offer regular
consultations with Parkinson’s disease patients or their carers
and this would include the following elements:
· Eliciting patients’ views and experiences of medicines
· Listening to issues and concerns
· Providing support and counselling on how medicines work, side effects,
interactions, dietary issues, practical aids to medicine taking, and
optimal dosage timing
· Offering written information
· Recommending other useful sources of information and help (eg, patient
organisations)
· Providing feedback to GPs and specialists, including recommendations
for prescription changes where appropriate
Home visits will be offered if required.
The pharmacists involved are to undergo a training programme to help
them deal with issues in Parkinson’s disease management. As well
as refreshing knowledge on the disease itself, it will specifically
include issues relating to the dosing and timing of medication, side
effects, compliance and concordance.
The project is the brainchild of Mary Baker, president of the European
Parkinson’s Disease Association and the late Bryan Veitch, who
advised the Parkinson’s Disease Society on pharmaceutical matters.
Mrs Baker told The Journal that the charity had found that sufferers
of Parkinson’s disease faced many problems in relation to medicines,
and could benefit greatly from the support of a community pharmacist
with special expertise. GPs often lacked the time to deal with their
difficulties. Both she and Professor Veitch had believed that, as highly
trained and accessible professionals, pharmacists could be doing more
for these patients. Their thinking coincided with Government interest
in the future role for pharmacy. They took their plans for increased
pharmacy involvement to pharmaceutical organisations, Government and
the pharmaceutical industry, all of which backed their ideas, which culminated
in this project.
Pfizer is providing £100,000 out of the £120,000 for the
study, with the remainder coming from Department of Health funding through
the Medicines Partnership. A steering group, jointly chaired by Baroness
Cumberlege and Howard Stoate, MP, is overseeing the project. The steering
group includes the chief pharmaceutical officer at the Department of
Health, two consultant neurologists, a Parkinson’s disease nurse
specialist, and a patient.
“This project should maximise pharmacists’ skills in a rewarding
way,” Ms Baker predicted. “If we get it right for Parkinson’s
disease, our vision is an accreditation in neurology, with modules for
multiple sclerosis and motor neurone disease as well.” A similar
approach is being investigated in Sweden and Italy, she added.
The Royal Pharmaceutical Society and the Department of Health, also involved
with the project, are looking for this study to lay the ground work for
the establishment of “pharmacists with a special interest” in
a range of disease areas.
With interested parties keen to involve pharmacists more actively in
the drug treatment of Parkinson’s disease, Pharmacy Alliance and
the Parkinson’s Disease Society carried out a survey to ascertain
the views of patients, pharmacists and GPs. It found a high level of
support.
With these positive attitudes, planning for the trial started in September
2003 with the scheme scheduled to run from July 2004 until March 2005.
Forty-one primary care trusts applied for involvement and three were
selected to participate. Six pharmacists from each of these areas will
recruit 10 to 15 patients each for the study, giving a total of 180 to
240 participants.
Measurable outcomes
Although not a randomised controlled trial, this project has measurable
outcomes which will include:
· Patient understanding and satisfaction with information about their
medicines
· Incidence of problems associated with medicines
· Health-related quality of life
· Demands on other parts of the health system
· Compliance with the agreed regimen
· Amount the service was used and experiences of using the service
· Interventions and referrals made by pharmacists
The pilot will be evaluated by Crispin Jenkinson at the Health Services
Research Unit, Oxford University. Professor Jenkinson has specialist
expertise in Parkinson’s disease, having developed a measure of
quality of life for this condition.
Evaluation will take the form of a longitudinal descriptive study of
participating patients using validated questionnaires for patients or
carers to complete, along with focus groups with selected participating
patients and pharmacists. In addition, the impact on participating pharmacists
in terms of their skills, knowledge and confidence will also be assessed.
The evaluation will be carried out from April to May 2005 and results
published in June.
Kauser Essaji, a participating pharmacist from O’Flynn’s
Pharmacy in Brighton, said: “These are the sorts of things the
Department of Health wants us to do and it will be wonderful if we are
going to help patients who don’t usually seek help.” |
The
Pharmaceutical Journal