Publication of results from CPF project demonstrates value of pharmacy in making real differences to patients’ quality of life
Community pharmacies are able to make significant improvements to medicines adherence and quality of life for patients with chronic obstructive pulmonary disease (COPD), leading to cost savings for the NHS through reductions in GP and hospital visits, a new study shows.
The full results from the Community Pharmacy Future (CPF) project’s COPD Support Service have been published in the peer-reviewed International Journal of Pharmacy Practice. Thirty-four pharmacies in the Wirral recruited 306 patients for the service.
Detailed analysis of records of patients who received the service for six months showed that more than 99% had an inhaler check at their initial visit, leading to more than two thirds (68%) changing their inhaler technique and/or spacer use, a third (36%) receiving smoking cessation advice, 91% healthy lung advice and 99% flu advice. Of these, 97% were subsequently recorded as having had a winter flu vaccination (vs 75% average in the Wirral area). In addition, two-fifths (42%) of patients received advice on physical activity, 39% on diet and nutrition, 19% on weight management and 15% on alcohol use. Following pharmacist consultations, 18% of patients were referred to their GP for further follow-up.
Patients were advised about obtaining “rescue packs” (antibiotics and steroids) and when these should be used for self-management of exacerbations. As a result, 56% more packs were issued to patients and there was a 122% increase in their use, showing that patients were able to recognise early signs of exacerbations and treat them quickly, thus avoiding the condition worsening rapidly which could lead to emergency admissions.
After six months, there were significant improvements in patient reported adherence to medicines (7% improvement on Morisky score). Quality of life scores (measured using EQ-5D) were also significantly improved. There were also positive changes in COPD status.
By collecting data on patients’ use of other NHS resources (including GP and A&E visits) and absences from work the study team were able to calculate changes in Quality Adjusted Life Years (QALYs), productivity gains and the overall potential value of the service to the NHS and wider societal benefits.
Researchers from the School of Pharmacy, University of East Anglia, who analysed the data calculated that there was a 97% chance that the service would be cost-effective to the NHS and society as a whole, measured against the NICE threshold of costing less than £20,000 per QALY gained.
Speaking on behalf of the CPF project team, Clare Kerr, Head of External Affairs, Lloydspharmacy, and a member of the CPF Management Committee, said: “Our work has shown that delivering targeted and tailored support for patients when they visit a pharmacy brings real benefits. Improvements in clinical outcome measures translated in to tangible benefits that patients and pharmacists noticed. Our patients were able to do more at home or in social activities and this improved satisfaction with their treatment, a key outcome objective for the NHS.
“There were also clear benefits for the NHS itself, with patients being supported to use their medicines in an optimal way. Obtaining and knowing when to use rescue packs gave patients greater confidence that they were in control of their own health, and flu vaccination rates were increased, reducing pressures on other parts of the NHS over a winter period.
“We have also demonstrated that this service can be delivered by pharmacies in a wide range of settings.
“We are very pleased that our CPF work has resulted in this robust addition to the evidence base supporting the commissioning of services from community pharmacies.”
The research has been published in IJPP (http://onlinelibrary.wiley.com/doi/10.1111/ijpp.12165/abstract)