Derbyshire Local Pharmaceutical Committee
Representing Community Pharmacy Contractors in Derby City and Derbyshire County
Chairman: John Sargeant MRPharmS
Email:
Secretary: Graham Archer B.Pharm. (Lond.), GPhC Registered Pharmacist Tel: 01246 433600 Fax: 01246 431897
Email:
www.derbyshirelpc.org
Address for LPC correspondence: Gunwalloe, 1 Rectory Close, Eckington, North Derbyshire, S21 4GL
November 2012
Dear Pharmacist,
Re: NHS targeted MUR Service (asthma) – developing synergies with GPs [Hardwick CCG ]
Dr Tim Parkin, of Limes Medical Centre, Alfreton (and prescribing lead for Hardwick CCG) hosted an event for local community pharmacists on Wednesday 22nd August, 2012 to discuss how collaborative working could support improved patient outcomes for Asthma and COPD patients. There are approximately 800 patients with asthma registered at this practice and they fall into two groups: (A) 10-20% who have unstable asthma symptoms & require a lot of clinical support; and (B) 80-90% who are fairly stable and generally need less support.
Pharmacists will also be aware that Derbyshire LPC has been running a series of Pharmacy Development Group meetings focussing on tMURs and NMS, including respiratory, and has been promoting an structured evidence-based approach to conducting t-MURs and NMS consultations with these patients. This Limes meeting therefore considered how this structured approach could be applied to support its asthma patients.
It was agreed to pilot a multidisciplinary team approach to Asthma Reviews to test how pharmacy (Medicines Use) Reviews and GP (Clinical) Reviews could be better co-ordinated to improve outcomes for asthma patients, whilst optimising the contractor interests of both the local pharmacies and the Practice. The following protocol was agreed:
· Limes Medical Centre [Limes MC] will identify those patients that have generally well-controlled asthma (i.e. stable patients)
· When such a stable patient is due for their annual asthma medical review they could be signposted to their regular community pharmacy for a t-MUR in the first instance.
· Community pharmacist will conduct a t-MUR and provide feedback to the Limes MC using a modified NHS MUR Feedback Form (example enclosed)
· The pharmacist will check & record smoking status, inhaler technique using an In-Check device, peak flow meter reading (not essential, but best practice), and get the patient to complete an Asthma ACT Questionnaire. The pharmacist may also provide additional information that might support the patient in the management of their condition – including lifestyle and education leaflets where appropriate.
· The completed t-MUR (modified) feedback form should be returned the surgery at the earliest opportunity for all asthma patients including those without any clinically significant matters arising, and the GP will have regard for the pharmacists comments when making their medical review considerations.
· The Limes GP will also use the information provided (especially smoking status, ACT Score and inhaler technique competency, as required by GP QoF and QIPP incentives) to update patient records and to provide feedback to the pharmacist on any recommendations they may have made.
· Limes MC to contact patient where issues are identified that require an appointment with a GP for further investigation.
The above protocol will provide an opportunity for pharmacists to work more closely with this practice and also for the pharmacy to benefit from the surgery actively signposting patients for such structured t-MURs (and NMS). And unstable patients will especially benefit as the practice will be able to spend more time on them, as they need extra clinical support. In addition, the t-MUR dataset captured for Group “B” (the relatively stable) patients will help the practice to maintain a more up-to-date patient record which is in the patients interests as well.
This is a fantastic opportunity to support asthma patients and so Derbyshire LPC would encourage all pharmacists in the catchment area of this Practice to fully support this pilot. Additional information on the LPC’s structured approach can be found on the presentations that were made at the Respiratory PDG Events earlier this year – http://www.lpc-online.org.uk/derbyshire_lpc/respiratory.html
Next Steps: Please complete the sign-up agreement form to indicate that you wish to participate in the pilot. The Limes MC will then be confident in referring asthma patients to you for such t-MURs. The form should be returned to Dr. Tim Parkin, Limes Medical Centre, Limes Avenue, Alfreton, Derbyshire, DE55 7DW.
I look forward to working with you all to make this pilot a success. Collaborative working will benefit patients through improved outcomes and benefit the wider health economy as a whole at a time when NHS resources are increasingly under pressure.
Yours sincerely,
John
John Sargeant MRPharmS,
Derbyshire LPC Chairman
Mob: 0786 628 1798
Email:
Encs. Pharmacist Asthma Review Pilot Sign-up Form
NHS MUR Feedback Form for Asthma Review Patients
Asthma Control Check Questionnaire
Multidisciplinary Asthma Reviews
Agreement to work with the Limes Medical Practice
[Hardwick CCG and Derbyshire LPC - August 2012]
I / We* ______please print
Of (Pharmacy Name and Address)
______please print
______please print
______please print
Telephone ______
Fax ______
Email ______
I agree to provide those asthma patients referred to my/our pharmacy from Limes Medical Practice with the following service:
· Conduct a t- MUR and provide feedback to Limes MC using the modified NHS MUR Feedback Form
· Check smoking status, inhaler technique (using an In-Check device), peak flow meter reading (not essential, but best practice), ask the patient to complete an Asthma ACT Questionnaire, and provide additional information including lifestyle and education leaflets where appropriate.
Return the completed feedback form to the Limes MC (fao Dr Parkin) at the earliest opportunity
Signed: ______Pharmacy contractor
Position: ______
Date: ______
Return a copy of this form to Dr. Tim Parkin, Limes Medical Centre, Limes Avenue, Alfreton, Derbyshire,DE557DW.
NHS Medicines Use Review Service – Asthma Review Pilot [Hardwick CCG and Derbyshire LPC]
To: Limes Medical Practice, Limes Avenue, Alfreton Date:
Re: Patient Name: DOB NHS Number:
Patient Address
This patient recently received a Medicine Usage Review [MUR] in line with the agreed Asthma Review Pilot and the results of the review are detailed below:
Smoking Status / Smoker / Never Smoked / Ex-SmokerInhaler Technique / Excellent / Good / Poor / Below range / In range / Above range
Peak Flow Meter / litres/min
Asthma ACT Score / out of 25
Patient Education
Lifestyle Leaflets
Education Leaflets
Medicine Names:
o Potential Drug interaction(s)
o Potential side effects/adverse drug reaction preventing use of the medicine
o Patient reports not using the medicine any more
o Patient reports not using the medicine in line with directions
o Patient reports difficulty using the medicine – issue with device
o Patient reports difficulty using the medicine – issue with the formulation
o Patient reports lack of efficacy
o Patient reports problem with drug regimen
o Patient reports unresolved concern about the medicine
o Other (see comments below)
Further information/Comments/Possible Action:
I have advised the patient that, where appropriate, the practice will contact them regarding this matter after considering the above information.
Please provide any necessary feedback to me on the outcome.
Pharmacist Name: Telephone:
Pharmacy Name: CONFIDENTIAL
Asthma Control TestTM
Your answers to this 5-question quiz will provide you a score that may help you and your doctor determine if your treatment plan is working or if it might be time for a change.
1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
All of the time Most of the time Some of the time A little of the time None of the time
2. During the past 4 weeks, how often have you had shortness of breath?
More than once a day Once a day 3 to 6 times a week Once or twice a week Not at all
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
4 or more nights a week 2 or 3 nights a week Once a week Once or twice Not at all
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as salbutamol)?
3 or more times per day 1 or 2 times per day 2 or 3 times per week Once a week or less Not at all
5. How would you rate your asthma control during the past 4 weeks?
Not controlled at all Poorly controlled Somewhat controlled Well controlled Completely controlled
Total Score □
Each question is scored from one (poor control) to five (good control) and the scores added to give a final score with a maximum of 25.
Copyright 2002 by QualityMetric Incorporated.
ASTHMA CONTROL TEST is a trademark of QualityMetric Incorporated.
ASTHMA ACTION AMERICA is a trademark of GlaxoSmithKline.