Medicines
Management
Issue no 5, p5-6
September/October
2002
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Medicines
Management |
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Features |
Pharmacy-based osteoporosis screening a success for all concerned
Of all the things one could expect to find in a pharmacy, a dual energy x-ray absorptiometry (DXA) scanner is probably one of the least likely. According to the National Osteoporosis Society, DXA machines to diagnose osteoporosis are currently available in 170 centres in the UK, but most are used for less than three days a week due to lack of funding. Yet a recent survey of screening services available in pharmacies revealed that a small number of them are starting to offer new services such as osteoporosis screening (PDF 40K) (International Journal of Pharmacy Practice 2002;10 (suppl):R51), including one in east London highlighted in the last issue of Medicines Management (July/August, 4, p4). Yardleys Pharmacy in Romford has just successfully completed a month-long, pharmacy-based osteoporosis screening pilot project, with the help of a portable DXA scanner about the size of a shoe shine box, that was loaned to the pharmacy by Havering Hospital National Health Service Trust. Supported by local community Project lead and secretary to the North-East London Local Pharmaceutical Committee, Hemant Patel, says both the local elderly population and GPs who have been involved in the scheme have been fully supportive of it. "It is important that community pharmacy is seen as a setting for chronic disease management. You can have near patient testing in the pharmacy, health promotion and high quality advice, medicines management, and pharmacist prescribing all put together in one setting, which will help patients considerably," he suggests. Indeed a survey of 133 service users, done as part of the project assessment, found three-quarters of them thought the pharmacy setting was more convenient than a GP's surgery. So as well as improving access to NHS services and smoothing the patient's journey, Mr Patel says this approach also reduces pressures on other areas of the NHS, particularly general practice. Multi-professional team The project involved Havering Primary Care Trust's pharmaceutical advisor, the local consultant rheumatologist, an osteoporosis nurse, the community pharmacist and pharmacy assistants, and three GPs within a mile radius of the pharmacy. There was extensive communication between all parties through meetings, where presentations and discussions took place, allowing a sharing of expertise and an understanding of everyone's point of view. Posters advertising the scheme were displayed in the pharmacy itself, the participating GP surgeries and the local hospital rheumatology clinic. In addition, at-risk patients, taking long-term corticosteroids, were identified through their medical records. High and low risk patients helped The screening was targeted at the at-risk group, and those aged 60 years and over. People asking about the service who were not in these categories were given health promotion advice only. The target group were asked to fill in a risk assessment form, a copy of which was given to their GP, which identified them as being either at high or at low risk. Those at low risk were offered advice on bone health and falls prevention, while those at high risk were invited for a bone densitometry scan. If patients declined a scan, they were offered bone health and falls advice, and the pharmacist informed their GP of this. People who wished to access the service, but who were registered with practices not involved in the pilot were given information leaflets and advice on bone health. In addition, if they had filled out a risk assessment, they were advised to take it to their GP, who was also contacted directly by the pharmacist. The pharmacy scanned heel bone density in 179 people over the duration of the project. Of these, one in five (36 people) were found to have osteoporosis and 46 were found to be osteopenic. "The GPs had told us that they had screened the population only six months previously, so to find such a large number with osteoporosis was surprising," Mr Patel says. "They were very grateful to the pharmacist." People identified as having osteopenia were given health promotion advice and the results passed on to their GP, while those with osteoporosis were referred back to their GP, who prescribed risedronate. Patient group direction comes next However, it is hoped that in the next stage of the project, a patient group direction will be in place to allow the pharmacist to prescribe medication directly to those found to have osteoporosis, without patients having to go back to their GP. Mr Patel is hopeful that the pilot will be rolled out across the PCT and says the service would be developed so that pharmacists would do the risk assessment, provide health promotion advice and, if necessary, arrange a time for the patient to be scanned at the pharmacy. An osteoporosis nurse would circulate around local participating pharmacies with the portable scanner and scan batches of patients together. Mr Patel says: "The patient could be out in 15 minutes with the knowledge they have been given good advice and up-to-date treatment. The interesting thing is that just over three-quarters of patients in our survey said they would be happy for the pharmacist to prescribe. This is one way to build the public's confidence in the NHS." A few other improvements to the scheme have been mooted in the event of a PCT-wide roll out. These relate to ensuring adequate space and more privacy. In addition, it has been suggested that more can be done to raise awareness of the screening programme, since only 2 per cent of people actually became aware of it as a result of the posters placed in GP surgeries. It could also be prudent to target people aged below 50 years, who could be screened earlier. Communication crucial However, Mr Patel stresses that communication between all those involved, especially in the initial stages of the project, is crucial: "There is an issue about communication. If this model is to be followed in other areas, I would urge people to make sure there is good communication between the pharmacist and the GPs. "We were keen to ensure that a strong partnership was formed prior to the project. Inter-professional politics and prejudices were overcome and now a stronger team is looking at other projects, including diabetes, based on a similar model, which could begin early next year." |
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