WE decided to explore the benefit of community pharmacists in GP practices, so we involved a community pharmacist (i.e. me!) in chronic disease management clinics within a GP surgery.
Pharmacists and general practitioners have similar common interests. They both want to treat and manage illnesses. They also both have a strong desire to provide high quality patient-centred care involving patients in the decision making process throughout.
Simon Steven’s Five Year Forward View and a recent report by the Primary Care Workforce Commission state the argument for a wider array of skills in primary care. A GP workforce crisis makes this more urgent and increasing the role of pharmacists within community pharmacies or GP surgeries can be one part of the solution.
Collaboration and joint care by pharmacists and GPs can only be good for patient outcomes. In my view pharmacists, GPs and other health professionals working together as a team and will play a role in the future development of the NHS. Building long term cohesive partnerships with GP’s by complementing each other’s skill sets will ultimately improve the care of their patients.
Pharmacists can play a significant role in managing patients with long term conditions such as asthma and COPD.
Recently I had the opportunity to work with Dr Andrew Whittamore a GP at Crookhorn Surgery in Portsmouth, Primary Care Lead Wessex AHSN Respiratory Programme and Co-chair PCRS-UK Conference.
He took me under his wing to help me to experience the delivery of respiratory care in the community. I had the opportunity to work within the practice providing routine asthma reviews.
It was interesting to see where my skills as a community pharmacist could be useful to the practice and, of course, to patients. It was also an experience to understand the demands, constraints and privilege that comes with the patient-professional interaction within a GP surgery.
The diagnosis of asthma is still largely a clinical one so a thorough history is vital. I took patient histories and used these to identify asthma symptoms like wheezing, shortness of breath, chest tightness, coughing that wakes them up at night or earlier than usual in the morning. I used the asthma control test throughout to attempt to gauge the severity of asthma in each case. This is a quick and simple way to assess the patient to see if the asthma is controlled or not.
In many cases the symptoms of asthma are fully controllable. By this I mean that if, as clinicians, we can coach the patient correctly on their personal asthma plan, then there is no reason why this chronic disease should interfere with day to activity like exercise or sleeping.
There are many very simple ways that a practice based pharmacist can intervene to support the patient with asthma.
I saw that 70% of the patients I assessed were not taking the medication as prescribed or not adhering to the medication perfectly. I noticed significant variation in the reliever inhaler usage.
An objective way to assess inhaler technique is to use the ‘in-check’ device. It can also aid the decision making process as to which inhaler would suit the patient best. The inhalation rate by a patient when using an inhaler is critical to delivering the dose effectively. Coaching a patient on how to inhale correctly when using their inhaler can have a beneficial effect on asthma control.
Another simple intervention I made during my time in the practice was to fully explain the clinical purpose of each inhaler. I reminded patients that their steroid inhalers had to be used regularly to fight the inflammation in the lungs that lead to asthma symptoms. I followed this up by explaining that the reliever inhaler was used for emergency situations and when symptomatic.
The use of the personalised asthma plans that I discussed with patients detailed the steps to take to control asthma symptoms under normal circumstances but also contained information on what actions the patient should take if symptoms deteriorated. The Asthma Control Test is a useful way to remind patients what they should expect to achieve in terms of asthma control.
I took a holistic approach to the care of the asthmatics I consulted with. I broached subjects like smoking cessation or weight management when appropriate. Both of these interventions can improve outcomes in asthma care. I even had opportunity to refer patient to a health trainer within the GP practice for their weight and therefore was pleased to be working as part of the multidisciplinary team.
I found the whole experience inspiring and want to extend sincere thanks to Dr Whittamore for allowing it to happen.
The future is bright for pharmacy and perhaps it’s time for more pharmacists to work in GP practices as an essential component of the multidisciplinary team. Collaboration is surely the secret to best supporting patients.
There are many great resources for pharmacists on the Primary Care Respiratory Society UK website including tools and resources on asthma, copd, conducting an effective review and the various medications used in these conditions.
Please visit Asthma UK for the asthma control test, self management plans and access to other great resources to help your patients manage their condition more confidently.
Hala Jawad is a GP practice pharmacist, RPS public health network moderator and member of the Surrey LPF steering group
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