The Pharmaceutical Journal
Vol 279 No 7463 p121
4 August 2007

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LPC gathering evidence to support commissioning

Evidence to support commissioning of new pharmacy services is to be gathered as part of a medicines use review initiative being delivered across Hampshire and the Isle of Wight.

The scheme is being run by the Hampshire and Isle of Wight Local Pharmaceutical Committee. Mike Holden, chief officer of the LPC, told The Journal: “One criticism of MURs, and of new pharmacy services generally, has been that there is little evidence of the benefits they deliver. We are hoping this scheme can act as a counterpoint to that.”

The reviews conducted as part of the initiative will focus on compliance issues of patients with asthma and involve more work than a normal MUR, Mr Holden said.

The LPC will be looking at whether the patient has seen a GP or nurse about his or her asthma over the past 12 months, whether the patient’s compliance issues result from beliefs, problems with medicines or difficulties with devices, and whether the issues were resolved by advice about medicines, checks on devices or referral to a GP or asthma nurse.

The LPC plans to develop a series of these services, which Mr Holden calls “MUR-plus” services, around osteoporosis, diabetes and mental health. “These reviews are slightly more robust than the average MUR and, in fact, probably do go outside the limits of the MUR specification.” He added: “The reviews are only funded as MURs and so the project is also partly about generating evidence and feedback about compliance issues. That evidence should help support future proposals for pharmacy services.”

The osteoporosis reviews would, he said, look at compliance with treatment and calcium and vitamin D3 intake, as well identify those at high risk of falls and, possibly, go into domiciliary or care homes to try to reduce the number of unplanned admissions resulting from fractures.

The 50 pharmacies taking part in the initiative were selected on the basis of their track record of providing MURs, their work with other health care professionals and their commitment to attend training and support the scheme. Over 100 pharmacists and pharmacy technicians took part in three training evenings at the start of July 2007. The training was delivered by secondary care respiratory specialists and GPs and GlaxoSmithKline +Plus provided updated respiratory MUR packs.

The LPC will be amassing feedback on the service from GPs, asthma nurses and pharmacists, as well as looking at how satisfied patients are with the reviews.

Asthma was selected because it is an area of local need, Mr Holden said. “Around £23m per annum is spent in primary care on inhaled corticosteroids and bronchodilators across Hampshire and the Isle of Wight and, with an estimated 60 per cent of asthmatics non-compliant with some element of treatment, there would be a huge amount of wastage and unmet health goals if those medicines were not being used optimally. Also, pharmacists are familiar with asthma and feel comfortable dealing with the compliance issues that arise.”