Prescribing & Medicines Management
Issue no 2, p10-11
March/April 2003

Features

Blood pressure checks just for starters

A pharmacist-led blood pressure monitoring service has been so well received in one community pharmacy that the pharmacists are extending the range of medicines management services to include medication reviews for weight loss and diabetes.

The hypertension monitoring service was established at Studly Pharmacy, Warwickshire, under the auspices of pharmaceutical wholesaler Vantage's Health Watch medicines management initiative. Under this initiative, the pharmacy has provided hypertension reviews for more than a year — free of charge.

Community pharmacist Jon Porteous says: "I think it is a little added incentive for patients to come to the pharmacy. We were originally going to make a charge for the service, but off the back of this initiative we've sold six hypertension monitoring machines at several hundred pounds each to patients who wanted to do their own monitoring."

Type 2 diabetes patients identified

Now the pharmacy is identifying local patients with type 2 diabetes who might want to take up the offer of further medication review clinics. "We will be checking that they know how to take their medication properly, and monitoring their blood glucose and urine on a regular basis, and feeding back the results of those enquiries to their GPs," says Mr Porteous.

Any patients with type 2 diabetes who are experiencing symptoms are being offered the service, and the findings are followed up with the patient's GP.

Already the scheme has identified a handful of patients who were not taking their medication properly, or at the right time. The pharmacy has also realised that some patients under review required the labelling on their medicine to be in a larger typeface, to make it easier to read the instructions.

Although the scheme is in its early stages, and has been running for little more than a month, Mr Porteous hopes to introduce a facility for patients with type 2 diabetes to have their blood glucose checked if people are reporting symptoms. For now this service is also offered free of charge to patients, due to the low numbers involved. But in future, the pharmacy will bid for money to run the service from the government's local pharmaceutical services pilot scheme.

"Whether or not we will find the money I don't know, but we will definitely bid for it," Mr Porteous says.

Roll-out to other patients

He adds that the pharmacy also plans to roll out the service to other groups of patients, possibly those with epilepsy or asthma. "We could offer a medication review service for the elderly, but this is such as huge area that we are going to limit it to particular disease areas at the moment," he adds.

Good relationship with GPs

The pharmacy has extremely good links with local GPs and, in managing hypertension, Mr Porteous believes that the pharmacy service has at least helped to solve the phenomenon of white coat hypertension.

"Patients seem more relaxed when they come to the pharmacy for their blood pressure measurements, and less likely to develop this condition. We can also sit them down for 15 minutes or so and calm then down, which there is not always the time to do in a GP surgery," he explains.

It is a two-way process, with the pharmacy feeding back suggestions made from the medication review to the patients' GP, with permission from the patients. Vantage monitors the outcomes from the reviews, and provides training materials to the pharmacists taking part in the scheme.

Mr Porteous says that after studying the written materials and video training module provided by Vantage, he was happy that his level of expertise would enable him to carry out blood pressure monitoring. "My main concern was with medication reviews because it is so open ended. But if I come across something I'm not sure about I can read up on it or seek more advice."

So far, the service has recruited about 100 patients with hypertension, and 20 or so with diabetes and weight problems. Mr Porteous believes that similar medicines management schemes could potentially save the health service money.

"I can see us finding up to 300 or so patients with diabetes, and medication review could bring savings to the NHS as a whole. But to be honest, the PCTs are pretty strapped for cash, and unless there are immediate savings then I can't see them funding it except through LPS pilots," he comments.

Mr Porteous adds that his professional development as a pharmacist has also benefited from providing the service. "It means that rather than just handing out medication with a degree of counselling, there is a follow-up with a plan to see how the medication is working."

And as medication reviews by pharmacists become more common, Mr Porteous says that blood pressure monitoring could be just the first in a line of services, including monitoring anticoagulants like warfarin. "Reviews that have been taking place in a clinical environment could easily be taking place in the pharmacy. And what we've found with medication reviews is that anomalous dosages and cost savings can be found, and we can look for cost-effectiveness savings. The problem is paying for the pharmacist's time. But if we can show savings have been made then we should get the funding."