European Society of Clinical Pharmacy
Sharing good practice among nations
Suzete Costa: guidelines designed for adaption and translation |
Achieving optimal control of hypertension, through more active involvement
of pharmacists, is the aim of the pharmacy-based hypertension management
project. This is one of six intervention projects developed within the
EuroPharm Forum, a joint network between national pharmaceutical associations
and the World Health Organization regional office for Europe.
Suzete Costa from Portugal, task force manager of the project, described
how the forum aims to make the best use of community pharmacists through
the development of guidelines and model programmes. The guidelines are
intended to be adapted and translated to suit the working practices of
individual countries.
The pharmacy-based hypertension management project started in 1996 and
in 2001 a pilot programme was undertaken in six European countries. Ms
Costa described how the guidelines outline ways in which pharmacists can
provide a hypertension management service at three levels of intervention:
· Level 1, prevention Involves counselling patients about risk factors.
· Level 2, detection Involves screening for cardiovascular disease risk
factors,
including high blood pressure.
· Level 3, management Includes blood pressure measurement, reinforcing
compliance and advice on medicines and lifestyle.
The guidelines include tools for pharmacists to adopt or adapt, based
on models collected from other countries. For example, one tool is a patient
profile sheet onto which the pharmacist can record details such as the
patient’s weight, blood pressure, referrals and date of next visit.
The protocol and guidelines for the hypertension project, which have recently
been approved by the WHO regional office for Europe, are available
online
Ms Costa summarised pharmacist-based hypertension projects in other countries
based on reports sent to the forum. For example, in the Czech Republic
interactive pharmacist training courses about patient medication records
are taking place; Hungary and Poland have used the forum’s model
to develop their own hypertension programme; and, in the UK, point-of-care
testing forms part of the new community pharmacy contract.
Early experiences of UK supplementary prescribers
GP and patient feedback of supplementary prescribing
UK pharmacist supplementary prescriber Fiona Reid gave delegates
an update on the development and implementation of pharmacist prescribing
in the UK. She described the results from a patient and GP survey
conducted in the pharmacist-led heart failure and cardiovascular
risk clinics she runs in primary care.
Questionnaires were sent to
201 patients, with a response rate of 74 per cent. When asked whom
they would prefer to manage their hypertension, 88 patients (61
per cent) chose the pharmacist, 50 patients (35 per cent) did not
mind
and six patients (4 per cent) preferred their treatment to be managed
by a doctor.
Feedback from GPs (obtained from interviews) included
comments that their workload was reduced, that pharmacist prescribing
has improved the continuity of patient care, that treatment managed
by the pharmacist is quicker and more aggressive, and that pharmacists
were more likely than GPs to follow protocols and guidelines. |
Early experiences of pharmacist supplementary prescribers in the UK have
been positive and good progress is being made, Derek Stewart, senior lecturer
at the Robert Gordon University School of Pharmacy, Aberdeen, told delegates.
Dr Stewart described the results of the first national study of supplementary
prescribers, in which a questionnaire was sent to supplementary prescribers
registered with the Royal Pharmaceutical Society (n=518) exploring satisfaction
with the training course, subsequent prescribing activity and perceived
benefits and challenges of being a supplementary prescriber.
Over 80 per cent of subjects responded to the questionnaire, the majority
of whom had been registered pharmacists for less than 20 years.
Feedback on the training courses was positive. On a scale of 1–5
(where 1=strongly disagree and 5=strongly agree) a median score of 4 was
obtained for the following statements: the course fully met my expectations
and needs; I feel confident in my ability as a supplementary prescriber;
being a supplementary prescriber has been/will be a major change to my
day-to-day practice.
The results showed that 48.6 per cent of respondents were practising supplementary
prescribers, 79 per cent had written at least one prescription and, of
these, 87.7 per cent had performed a full medicines use review.
The main perceived benefit of supplementary prescribing was better patient
management, followed by job satisfaction. Of those who identified challenges
in delivering supplementary prescribing (n=127), the issues raised were
inadequate funding (21.3 per cent), the referral process/identification
of suitable patients (15 per cent), poor recognition of the pharmacist’s
role by other professionals (15 per cent), inadequate IT support (14.2
per cent) and inadequate administrative support (3.9 per cent).
Pharmacists who were not practising supplementary prescribing (n=205),
gave reasons including lack of organisational recognition, lack of funding,
non-availability of prescription pads and a change of job.
Dr Stewart said that supplementary prescribers need further support in
terms of infrastructure and integration into the health care team, and
that further outcomes-based research is warranted.
The research was carried out at Robert Gordon University in collaboration
with the University of Aberdeen and NHS Education for Scotland.
Paediatric medicine issues in the 21st century
Up to 65 per cent of prescriptions written in children’s hospitals
are for medicines unlicensed for paediatric use or are being used “off
label”, Tony Nunn, clinical director of pharmacy at Royal Liverpool
Children’s Hospitals NHS trust told delegates. He described the problems
caused by not having appropriate drug formulations for children, including
the difficulties and risks of extemporaneous dispensing and importing formulations
from other countries.
Mr Nunn described the new proposed European Commission regulation to encourage
pharmaceutical companies to develop medicines for children, which is due
for its second reading in the European parliament later this year. He explained
the role of the new paediatric committee at the European Agency for the
Evaluation of Medicinal Products in considering the benefit of carrying
out studies in children, and described the different types of rewards and
incentives that will be granted to companies who study medicines in children.
The regulation is likely to become law by end of 2006, Mr Nunn said.
He went on to outline other work being done at a European level, including
the establishment of an inventory of medicines used in children to help
identify research priorities, and a database of trials and authorised products
across Europe. However, he posed the question of whether Europe has the
infrastructure in place to be ready for this kind of research.
Interest in the BNF for Children from other countries has also triggered
the suggestion that it is time to consider a European formulary for children,
he said.
Antje Neubert: improving taste of drugs |
Antje Neubert, from the University of London School of Pharmacy, described
research into oral formulation and taste. Children find it harder than
adults to recognise different tastes, she explained, so unusual flavours
should be avoided for better acceptability. Social and cultural influences
also affect taste preferences. For example, research has shown that American
children prefer bubblegum and grape flavours, European children prefer
citrus and red berry flavours, and Japanese children prefer less sweet
formulations. She described methods used to assess taste including a
taste panel and an electronic tongue, which analyses the electric charge
caused
by the substance and compares it to taste standards.
Dr Neubert also outlined work from the Task Force in Europe for Drug
Development for the Young (TEDDY), a network of excellence for children
funded by the
EU Commission involving 17 research institutions from 11 countries, of
which she is deputy UK co-ordinator. They aim to promote research on
safe use of medicines for children and improve the use of current drugs.
Topics
covered include rare diseases, pharmacovigilance, paediatric databases
and ethical issues.
Education benefits TB patients
Clinical pharmacists can play a key role in the provision of pharmaceutical
care and education for patients with tuberculosis, Philip Martin Clark,
pharmacy tutor at Yeditepe University, Istanbul, Turkey, explained. He
presented research undertaken at Marmara University into TB education and
adherence to drug regimens, pharmaceutical care, quality of life and evaluation
of new drugs.
In one of the studies the impact of oral and written education tools on
compliance with drug therapy was assessed. Patients who were provided with
pharmacist-directed
education about their medicines showed better adherence to drug regimens
that those receiving standard care. Patients were given illustrated educational
material (in a question and answer format) or standard care, and adherence
was measured by recording attendance at scheduled clinic visits, urine
analysis for isoniazid (INH) metabolites and pill counting. The results
showed that the educated group were more likely to attend — 30 out
of 56 patients (53.6 per cent) attended 100 per cent of their scheduled
appointments in the educated group compared with 17/58 (29.3 per cent)
in the routine group. Positive results for all INH tests were recorded
for 41/51 (80.4 per cent) patients in the intervention group compared with
22/52 (42.3 per cent) in the routine group, and consumption of prescribed
medicines was also found to be higher in the educated group.
Dr Clark described a number of other issues that pharmacists should be
aware of when writing pharmaceutical care plans and forming strategies
to provide care for patients with TB. These include pain control, nutrition,
appropriate prescribing, respiratory control and diabetic control.
Patient beliefs about their medicines correlate
with adherence
Patient adherence to drug regimens involving
inhaled corticosteroids (ICS) is correlated with their perceived
benefit of the drugs.
Marcel Bouvy from the SIR Institute for Pharmacy Practice and Policy,
Leiden,
the Netherlands, presented a study undertaken in 11 community pharmacies
in the Netherlands into the perceived necessity and concerns about
inhaled corticosteroid use in asthma. A “beliefs about medicines” questionnaire
(BMQ) was sent to 458 patients using ICS and returned by 238. Results
were compared with adherence as measured from pharmacy dispensing
data and patient self-reporting.
A moderate correlation was seen between perceived benefit and patient
adherence to treatment. Dr Bouvy concluded that the BMQ is a useful
tool to assess patient attitudes in combination with medical and
clinical records and is reasonably predictive of adherence, so
can assist in
understanding barriers to use of the drugs. However, it does not
fully explain all causes of non-compliance. |
An Australian study of CVS pharmacists
Establishing the role of a specialist cardiovascular pharmacist in multidisciplinary
health care teams optimises medicines use in chronic heart disease sufferers.
This was the finding of a team from the Universities of Sydney and New
South Wales, Australia.
Alexandra Bennett, from the Faculty of Pharmacy, University of Sydney,
described how the specialist pharmacist role has been developed in three
settings: an outpatient heart failure clinic, a community heart failure
service and a cardiac rehabilitation programme associated with a major
teaching hospital. The role of the pharmacist included informing patients
about their medicines, self-care strategies, attending multidisciplinary
team meetings, performing individual consultations and visiting patients
in their home where necessary.
Ms Bennett described how this role has improved patient care and, although
hospital based, aims to bridge the gap between primary and secondary care.
She said that the service could be expanded to other disciplines and other
hospitals.
Other data from this study showed that the number of medicines taken by
a cardiac patient is a strong predictor for heart failure readmission.
For each additional medicine added to a patient’s drug regimen, the
risk of readmission in six months post discharge doubled (odds ratio 2.055,
95 per cent CI 1.477–2.858). |
The
Pharmaceutical Journal