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One in 500 people in the UK — around 120,000 individuals — has
Parkinson’s disease (PD) and about 10,000 people are diagnosed
with the condition each year, according to the Parkinson’s Disease
Society.
Each patient with PD responds differently to the available medicines,
and treatment therefore needs to be tailored for the individual patient.
Members of the health care team, including pharmacists, can play a role
in ensuring that PD patients have a good understanding of their medicines — often
prescribed in complex regimens — so that they are better able to
take some part in adapting the treatment to the nuances of their own
condition.
How community pharmacists might be a source of information for PD patients
was looked at in a pilot study, which ran for six months in 2004–05
(PJ, 10
April 2004, p442, and 31
July 2004, p139). The scheme took place
in 18 community pharmacies across three primary care trusts in England — Brighton
and Hove, Coventry, and St Helens. Patients recruited to the scheme visited
a community pharmacist to discuss issues relating to their PD medication.
An evaluation of the scheme was carried out by investigators from Oxford
University, the results of which are published in an Original
paper this
week (p709). In the published analysis the authors say that their results “suggest
improvements in patient satisfaction and potential effects on quality
of life in terms of self-reported physical function, possibly as a result
of the specialist pharmaceutical services”.
A follow-up questionnaire, asking patients about their attitudes to the
initiative, revealed some positive feedback:
• 61 per cent said they knew more about their disease after taking part
in the project
• 63 per cent claimed they knew more about their treatment
• 82 per cent claimed that the advice of the pharmacist was helpful
• 70 per cent claimed to have gained greater benefits from their drugs
since taking part
• 87.5 per cent said the pharmacist was knowledgeable about Parkinson’s
disease
• 90 per cent said the pharmacist listened to their concerns
• 87.5 per cent said they would recommend the service to others
The pilot scheme was one of a series of demonstration projects led by
the Medicines Partnership, established by the Department of Health in
2002 to promote the concept of concordance — or shared decision-making — to
help patients get the most from their medicines.
The Medicines Partnership was scaled back last year and is now part of
the National Prescribing Centre. Pfizer contributed £100,000 to
the PD project and £20,000 funding was made available by the DoH.
Being involved
Nigel Cosford, senior medicines management pharmacist at Halton and
St Helens PCT was involved strategically with the pilot when St Helens
PCT was a separate entity (before its merger with Halton PCT).
Mr Cosford says that the pilot benefited PD patients through improving
their access to health care services. He explains: “There is easy
access to community pharmacists and this can only be a good thing for
PD patients. The community pharmacists know the patient’s medicines
and can talk to them easily about them without the patient having to
wait for a lengthy time for an appointment to see their consultant, or
a few days to see their GP.
“Another benefit is identification of those patients who seem to have
little or no contact with secondary care PD services — specifically
PD nurse specialists — and signposting them to services that are
available.”
John Goes, one of the community pharmacists who worked with the PD patients
in the Coventry PCT area, says: “Someone was there to make sure
that the patient was taking their medicines correctly, at the appropriate
times, and helping the patients understand what each medicine was doing
and how it was doing it.” They were better able to make alterations
to improve the management of their own condition, Mr Goes believes.
“I think, in general, the patients were appreciative of the regular contact,” he
adds.
Future work
Mr Cosford says that Halton and St Helens PCT will be commissioning
a scheme similar to the PD pilot as an enhanced pharmacy service.
He explains that there have been delays due to organisational change: “The
PCT merger was bad in terms of time scales for continuing the scheme,
but good in that the current head of the medicines management team is
keen to roll this out across both old PCTs. Not every pharmacy will be
involved but we will hopefully get good geographic spread for easy patient
access across the new PCT.”
It is proposed that pharmacists’ reimbursement for providing the
enhanced service will be the same as that agreed for the pilot — £40
for the initial 40-minute consultation and £20 for the subsequent
appointments of 20 minutes, he points out.
Patients will be seen up to four times a year and the documentation will
be broadly similar to that used in the pilot. He comments: “A lot
of good work went into producing the documentation and we will continue
to use the consultation guide developed for the pilot.”
Providing a service for PD patients
Nigel Cosford, senior medicines management
pharmacist at Halton and St Helens PCT, provided the following
points to consider when
offering
a pharmacy service for patients with Parkinson’s disease:
• Commitment of the pharmacist operating the scheme is essential.
However, almost as important is the commitment and support of senior
pharmacists in multiples or small groups to ensure that the practising
pharmacists have the resources (time, staff, financial recompense)
to enable them to operate the scheme.
• Time management within each pharmacy must be good to ensure that
PD patients can be seen for up to 40 minutes, as well as at the
patient’s convenience (eg, pharmacists being available at
lunchtimes and after hours for housebound patients).
• Promotion and understanding of the scheme within GP practices
is important to encourage inclusion of the pharmacists as part
of the health care team in managing PD patients’ conditions. |
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The
Pharmaceutical Journal