Prescribing & Medicines Management
Issue no 2, p13-14
March/April 2003

Features

Pharmaceutical companies join in

Although pharmaceutical wholesalers have been offering a number of medicines management initiatives to community pharmacists for some time, the pharmaceutical manufacturers themselves have been less quick off the mark.

But that has recently begun to change, not least with the launch in December last year of GlaxoSmithKline's +Plus Medicines Support Service. Although the initial launch involved rolling out diabetes monitoring services in pharmacies, the company has been quick to recognise that many pharmacists want to play an enhanced role in providing comm-unity health services.

Linda Crane, director of commercial operations, GSK, says that +Plus in fact encompasses the company's whole range of medicines management support services.

"We see pharmacists as becoming of increasing importance, particularly the role they are playing in delivering health care, and medicines management plays a role in that," she told P&MM.

Pharmacists increasingly important

"Part of that is medicines support services, and a range of things that pharmacists can do in connection with medicines management projects. The main areas we focus on are asthma and diabetes, and we also have support services around depression," says Ms Crane.

The company provides information leaflets to pharmacists to help them talk to patients about symptoms they might be experiencing, or problems with their medication.

The diabetes service for the first time goes beyond simple support with patient information and education. Under the scheme, pharmacies that are taking part are provided with training and equipment needed to monitor glycaemic control, blood glucose, blood pressure and the body mass index of patients with diabetes.

Once the pharmacist has conducted the tests, a report along with the patient's prescription history is given to the patient, their GP and the PCT's diabetes register. This then provides an opportunity for the GP to review the patient, and take action such as changing their medication or dose if necessary.

The company arranges training for pharmacists, which usually takes place in the evenings or on a half-day basis. Training covers not just how to use the equipment and monitor patients, but also how to talk to them about what the readings might mean in terms of symptoms and management of their illness.

A report is then usually prepared by the pharmacist, and a copy sent to their GP, with the PCT in some cases getting data back from the pharmacist consultation as well.

GSK is careful not to collect or monitor its own information from the scheme due to patient confidentiality, which it is keen to protect. "We get general information back about how medicines are being used, but not patient-specific information," says Ms Crane.

Asthma care pack also available

A further example of GSK's +Plus medicines management service is the asthma care pack. This is available to all pharmacies, and contains a range of tools to help patients with asthma, such as leaflets explaining their medicine, and information for pharmacists about talking through issues about using medicines with patients.

The pack also contains details of simple questions that the pharmacist can ask the patient, which provide an early warning of uncontrolled symptoms.

"These might be questions such as do you find you are getting wheezy when you exercise, or do you wake at night, for example?" says Ms Crane. The questions are arranged into scoring cards for symptoms, which the patient can then take to their GP to discuss their treatment at the next consultation. The packs are provided free of charge, as part of GSK's commitment to supporting community pharmacy, says Ms Crane.

Mindful of the interest being shown in medicines management by community pharmacists, GSK sponsored a concise summary of the different medicines management initiatives that are taking place, aware that there was a real thirst for information about the new schemes. This summary, written by Dr Hooman Ghalamkari, has been sent to all pharmacists along with the offer of a free copy of the National Prescribing Centre's publication Modernising Medicines Management, which has been requested by more than 1,800 pharmacists so far.

Are pharmacists engaged?

But how much interest has there been among pharmacists in taking up GSK's offer of support in medicines management, rather than just requesting information?

Ms Crane says that at the moment it is difficult to say. "The diabetes initiative runs across 30 pharmacies but it is a pilot – we're in wait and see mode really." However, the level of interest from pharmacists can be gauged to some extent by the number who have requested the asthma packs, which was 600 at the last count.

Although GSK has paid some pharmacists in the past for taking part in specific medicines management projects, it does not see this as a way forward in future.

"It's not something that we would build into our scheme. We don't have a role in terms of remuneration but do understand that many pharmacists have concerns about the time that is taken with doing medicines management," Ms Crane points out.

Nevertheless, the company says that it sees medicines management as playing an important role in increasing patient satisfaction with their medicines.

"We view the whole development of medicines management schemes very positively. What is of paramount importance to us is that patients get the best value from their medicines that are prescribed and so to me the pharmacists' extended role is really key to that."

Ms Crane adds that it is not just GSK, but the pharmaceutical industry in general which recognises the increasing importance of medicines management. This seems to be borne out by the interest generated in last year's conference, organised by the Association for the British Pharmaceutical Industry, Making the Most of Medicines Management, which attracted delegates from pharmaceutical companies, PCTs and NHS hospital trusts.

Earlier this year the Royal Pharmaceutical Society published its advice to pharmacists on joint working with the pharmaceutical industry, aware that there were an increasing number of opportunities opening up for both parties. The guidance says that the increased interaction between pharmacists and industry was welcome, and that there were clear mutual benefits.

Ethical and probity issues

But the Society did warn pharmacists that they should be aware of their responsibility to conduct relationships with commercial organisations "in accordance with ethical and professional standards and with due deference to probity and corporate governance arrangements".

Although the guidance is intended for many pharmacists working within NHS organisations who might come into increasing contact with drug industry representatives, a vital area for community pharmacists is that fact that they work at the interface where companies' medicines meet the patients.

The most likely area of difficulty for pharmacists providing medicines management services might involve ensuring that any medicines management support services are non-product specific, focusing instead on disease states alone.

Alison Blenkinsopp, professor of pharmacy practice at Keele University's department of medicines management, says: "Potentially there's a lot of scope for joint working around support for patients. But without knowing more about the sorts of schemes it's difficult to comment. If the scheme were product-based a potential issue might be does this create an inequity for patients who have the same condition but have been prescribed another company's drug?"

The other points about joint working of which pharmacists should be aware are to ensure that any hospitality attached to the offer to attend an educational meeting is not out of proportion to the occasion.

"The costs should not exceed the level that the recipients would normally adopt if they were paying for themselves," states the guidance.

Meanwhile joint working in the area of medicines management looks likely to increase, particularly as all PCTs must have medicines management schemes in place by 2004 — it seems a fruitful ground for partnership working.

GSK is certainly committed to continuing to develop its services. "Since the launch of +Plus we've been putting in a lot of effort to support pharmacists," says Ms Crane. "The +Plus project is open-ended, not a fixed term project, and is how we're describing our whole range of services that we're offering to pharmacists."

Is there a future under LPS?

In fact, the future could see some of GSK's projects being adopted at local level by PCTs under LPS pilots. Ms Crane says: "We do believe that some of the projects would be suitable for providing under local pharmaceutical services contracts.

"While we are not talking to any PCTs specifically in this area, our door would be open to anyone wanting to become involved, as long as it fitted with our expertise as a company. What this is all about is supporting pharmacists to enable patients to get more from their medicines."

Pharmacists wanting a copy of the NPC publication, Modernising Medicines Management can order a free copy by ringing GSK's customer care line: 0800-221441.