Pharmacy in Practice recently hosted a roundtable discussion on behalf of Thea Pharmaceuticals on dry eye management. There was considerable pharmacy and optics expertise in the room so what were the thoughts on the opportunities for community pharmacy in this space?
The purpose of the roundtable event was to explore the challenges and opportunities for pharmacy particularly in the area of optics and specifically dry eye.
The day was chaired by Johnathan Laird owner of Pharmacy in Practice.
- Saam Ali – Pharmacy Mentor.
- Micheal Stewart – Freelance medical writer.
- Diane Leicester-Hallam – Director of member services at the PDA.
- John Hamill – GP pharmacist.
- Jane Lambert – CEO of ECG training.
- Mital Thakrar – Change implementation lead at Well Pharmacy and managing Director at Team PreReg.
What are the key issues in community pharmacy in the area of dry eye?
“Hypromellose has for many years been the product of choice. Much of the use of hypromellose has perhaps been driven by habit. Hypromellose is cheap and patients will come back again and again. There are now products that are preservative free. If preservatives like benzalkonium chloride can actually disrupt the tear film then we should really be recommending preservative-free products.”
“Many eye preparations that are used long-term can cause disruption of the tear film and therefore some irritation. Now that Thea has a multidose bottle there is an option to go for preservative-free eye preparations.”
“I think as pharmacists are all guilty of sticking with what they know. In the dry eye world, hypromellose is that long-standing trusted old favourite. Perhaps it is time to do more and perhaps choose preservative-free products and deliver much better pharmaceutical care.”
What is the community pharmacy environment like at the moment?
“There seems to be so much happening in community pharmacy. It feels like the perfect storm of Brexit, falsified medicines directive (FMD) and funding are all huge issues for community.”
“Many community pharmacists feel really undervalued and many community pharmacists are moving out of community and into new roles like pharmacists working in general practice. Community pharmacists didn’t feel bought into the practice of pharmacy in community. There seems to be low morale in community. The changes in locum rates and movement of pharmacists out of community pharmacy is having a big impact on those left in community.”
“As a pharmacist, there is a professional obligation to do your best for the people that access your services however it is really difficult to do this brilliantly in the current environment. There is always too much bad news in pharmacy and most of that feels like it is coming from community. There are lots of really positive things happening and I wish we could hear more about these things. We need to shout about how important patient safety is as a foundation for modern pharmacy practice.”
“Pharmacy teams are the key to this positive direction. They need training and educational support delivered in a bite-size way to increase their knowledge in a particular clinical area.”
When would community pharmacists engage with people with dry eye?
“People with dry eye are often identified by counter staff and referred to the pharmacist. The pharmacist will deal with these queries and make appropriate recommendations. Again, hypromellose is the usual choice and may not always be the most appropriate choice for the patient especially long term.”
“We know for example, that benzalkonium chloride can disrupt the tear film. Are we making this clear to patients especially when they present to the pharmacy for further supplies of dry eye drops Little tips are really helpful e.g. shelf-life or the technique required to administer an eye drop.”
“Every community pharmacy in the UK should have a dry eye champion.”
What is the biggest limiting factor in community pharmacy at the moment?
“Time. Community pharmacy is so busy. Any information that is transferred or delivered to pharmacy teams must be delivered efficiently.”
“Community pharmacy teams have a massive role to play in diagnosing dry eye conditions. In addition, they have a large role in diagnosis. Without the correct training, profits will follow.”
Should we highlight the profitability of dry eye products?
“The return on investment in community pharmacy is definitely a consideration. It is ok to make a profit but the patients accessing the services must be front and centre of everything we do. It has to be a combined effort to improve health. In this case better diagnosis and management of dry eye will certainly lead to a more profitable business.”
“Simple messaging is best. Simple messages that allow much better delivery of pharmaceutical care. There are comparisons with how pharmacists have taken the initiative with asthma around inhaler technique.”
What does success in community pharmacy mean?
“There is a buzz out of making preventative medicine real. Deploying messages to patients that resonate and have a tangible impact is obviously excellent for the patient but for the pharmacist, it is a wonderful feeling to know that your advice has really helped someone feel better. From a business perspective if people who access your services have a positive, or even potentially a life-changing, outcome then they will talk really positively about the business.”
Are validated questionnaires useful in diagnosing dry eye syndrome?
“There are dry eye validated questionnaires out there. They are easy to deploy and community pharmacy could be an excellent place to deploy such questionnaires. It is about understanding how the patient is managing with their dry eyes at that moment in time. These questionnaires could be a great conversation starter too. Pharmacy teams could deploy them and pharmacists could have the conversation afterwards.”
What terminology should be used in this area?
“If you feel your eyes then you probably have an element of dry eye syndrome. People who get ‘screen eyes’ do so because their blink rate is reduced due to increased levels of focus on the screen. After using a screen for some time, the blink rate can drop off and increase the risk of dry eye problems.”
What is the top line direction of travel for community pharmacists supporting people with dry eye syndrome?
“For me, it’s all about the ‘why’. Why preservative free? Interruption of the tear film by preservatives like benzalkonium chloride is significant. If preservatives can disrupt the tear film in the medium to long term is a problem.”
“We need to raise the profile of eye care. Community pharmacists have a massive role in this.”
“Administration of the eye drops is a key point. There are now bottles that are available that are able to administer multiple doses of preservative-free drops. The traditional method of delivering preservative free drops is via single-use bottles. This is wasteful and not very environmentally friendly either.”
Is there a role for the third sector or charities to support patients with eye problems?
“Community pharmacists could network with local and national charities to help support patients with dry eye troubles. Charities are looking for willing partners in the hearts of communities across the country.”
What demographics of people need most help?
“Dry eye has an impact on all ages. Traditionally we think of older people suffering from dry eye. However, more commonly the younger generation is suffering. With the proliferation for screen use, the blink rate is suppressed and therefore dry eye becomes a problem. Many young people heavily use screens these days and possibly need support.”
If community pharmacists identify a problem what referral pathways are available?
“Collaboration with other healthcare professionals including opticians is critical. The patient journey in any clinical condition is critically important. Do these referrals impact others? We should be working much more closely with our optician colleagues.”
“What I worry about is people being passed from pillar to post. Someone has to take responsibility and in the area of dry eye community pharmacists are well placed to make an intervention. Medication use reviews are rather target driven and we need to add quality into that process. Delivering this well is critical to delivering an excellent patient journey.”
“The lack of access to the patient record is detrimental to this patient journey. As community pharmacists, we can’t see what has been happening elsewhere either at the optician or at the GP practice. This really needs to change.”
How can community pharmacists grow their confidence?
“Its all about relationships. Time to train is important. Fitting in training and development is really important. Short face to face training and peer support at a time they can manage is effective.”
“The possibilities for community pharmacists are huge but times are tough. They need to be brave and seize the day.”
Thea Pharmaceuticals Limited is an innovative ophthalmic research and development company dedicated to developing high-quality, preservative-free products which provide patients with the ophthalmic care they deserve. Their extensive product range covers numerous important areas relevant to ocular health, including prescription products for Glaucoma, Infection, Inflammation and Allergy as well as a range of cutting edge Surgical pharmaceuticals.
They also have preservative-free treatments for Dry Eye, Eyelid Hygiene and Meibomian Gland Disease along with a range of Eye Nutritionals to help protect vision. Thea Pharmaceuticals has three strategic pillars which are reflected in our company ethos – “Driving Innovation, Education and Professionalism in improving Eye Health”. As the leading independent company dedicated to ophthalmology in Europe, Thea are committed to supporting Ophthalmic professionals and to meeting the everyday needs of the ophthalmologist.