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Pharmacist

Pharmacists are ideally placed to support patients with COPD form providing advice on medication to signposting to other healthcare professionals where needed. Below are a few of the services offered by community pharmacies that could benefit COPD patients.

1. New Medicines Service (NMS)

This service focuses on patients with long-term conditions who have been prescribed something new to improve adherence and reduce wastage of medicines. It also allows patients to be involved in decisions about their treatment and helps with self-management. COPD is one of the five clinical conditions that NMS is focused on along with asthma, type 2 diabetes, antiplatelet/anticoagulation therapy and hypertension. Patients are either referred for the service by the prescriber or offered it in the community pharmacy when collecting a prescription for a new medicine.

2. Medicine Use Review (MUR)

Is a service designed to help improve a patients understanding of their medicines, improve adherence and to reduce waste. It is also an opportunity for patients to ask questions about their medicines if they are unsure of anything. 70% of MUR’s are targeted to specific groups of which respiratory disease (and so COPD) is one. Other targets include high risk medicines (e.g. anticoagulants, diuretics), recently discharged from hospital and those taking four or more medicines (including one of cardiovascular, diabetes, and thyroid) and so have a cardiovascular risk. A COPD Assessment Test (CAT) is a measure that has been used in COPD MUR’s to measure the impact and if the disease is controlled (low score = low impact). To view the CAT test visit http://catestonline.org/images/pdfs/CATest.pdf.

3. Inhaler technique

It has been estimated that around 50% of patients are using their inhaler incorrectly however around 90% of healthcare professionals are unable to demonstrate all the steps required for the use of a metered dose inhaler. Pharmacists are therefore ideally placed to help teach patients inhaler technique as patients will see them regularly. For further information see Inhaled Therapies Devices page.

4. Smoking Cessation

As smoking cessation is the most effective intervention in COPD and pharmacists are ideally placed to offer advice and support. As well as selling NRT as OTC medicines some also use Patient Group Directions (PGDs) to supply therapies on the NHS. For further information see Smoking Cessation page.

 

Carbon monoxide testing: Many pharmacies also offer carbon monoxide testing to assess before the person quits and then after they quit. It is quick and non-invasive and can act as a motivation for patients if they see the readings decreasing.

5. Further advice

Weight: Patients should be offered advice on nutrition to maintain a healthy weight, some will lose weight due to decreased eating because of symptoms while others may gain weight as they are immobile.

 

Exercise: They should be encouraged to exercise at their own level while not straining themselves as this will help with their breathing. Many patients feel anxious about exercising and this encouragement may help them understand the importance of it. The may be referred for pulmonary rehabilitation.

 

Vaccines: COPD patients should be encouraged to get their annual influenza and pneumococcal vaccines. Some pharmacies now offer an annual influenza service.

6. Future opportunities

COPD clinics could be run by pharmacists with spirometry taking place in community pharmacies rather that patients visiting GPs or hospital. An independent prescriber community pharmacist in Aberdeen, Scotland started doing this in 2005. She uses a clinical management plan (CMP) to involve the entire healthcare team. Her aim is to optimise treatment and improve patient complicance. For further information on this story visit http://www.pharmaceutical-journal.com/careers/career-feature/helping-copd-patients-in-the-community/10045485.article

 

There may also be the opportunity for pharmacy COPD screening to identify those with COPD earlier. A pilot study took place between September 2012 – April 2013 in the Wirral, England where 56.7% of participants were identifies as being at risk of having undiagnosed COPD. It has been suggested that a programme such as this could save around £264million a year. For further information visit http://www.pharmaceutical-journal.com/news-and-analysis/news/pharmacy-copd-screening-could-save-the-nhs-264m/20067114.article

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