MORPh Speaker Blog – Amit Patel
I’m Amit, a respiratory speaker for MORPh Training and some of you will have met me at the study days in the North of England – mainly Liverpool and Manchester but possibly other locations too. I am going to start writing in this blog about various aspects of Respiratory care that I feel that may be useful for all those practice pharmacists who are embarking upon their journey in GP practices.
As you may know, I am a Respiratory Specialist Pharmacist and have led on several Asthma and COPD Medicines Optimisation projects in the North West; however, I also work in a GP practice in Liverpool as a Clinical Practice Pharmacist and Independent Prescriber. I have specific COPD and asthma clinics at the practice but also have general medication review clinics in which I review patients with long term conditions such as: hypertension; diabetes; AF and anxiety/depression.
So, let’s go back to basics and set the scene – You have settled into working in your GP practice and after a few months, one of the GPs asks you for your advice or opinion on the vast number of prescription queries they are receiving in the practice for Salbutamol inhalers.
What are you going to say or suggest?
This is a common scenario in GP practices and one in which, us GP practice pharmacists can really sell ourselves and show what we are capable of.
We know that overuse of a Short Acting Bronchodilator Antagonists (SABAs) can lead to further complications. UK asthma guidelines state that using SABA at least three times a week is a marker for potentially poor control and a predictor of future risk of asthma attacks and death and The National Review of Asthma Deaths “Why asthma still kills,” (NRAD) recommended that prescription of more than one SABA per month should trigger an asthma review.
So, you can use the information from the NRAD report to support your proposal of setting up an Asthma clinic in your GP practice.
Firstly, I would suggest arranging a meeting with the practice manager, GP and nurse in your practice in order to discuss the proposal of setting up an asthma clinic. Based on my experience, you will need to reassure the nurse that you are proposing this to help support them and take some workload away from them as they may be doing asthma, hypertension and diabetes reviews ALL in 30 minutes. By creating a specific asthma clinic, you will be able to review patients and optimise patient care by providing the following:
- Peak flow monitoring
- Determining asthma control by using the Asthma control test questionnaire
- Inhaler technique assessment
- Education re non pharmacological interventions
- Personalised asthma management plans
- Stepping up or stepping down medication as appropriate
- Medicines optimisation
Once you have engagement from the practice, the following will need to be discussed:
- Room availability , clinic dates, appointment duration and times
- Equipment including access to placebo devices; Incheck Dial to assess inhaler technique; patient information leaflets / booklets etc.
- Further education i.e. any gaps in knowledge and how to overcome them e.g. arranging to shadow the community respiratory team
- Which cohort of asthma patients need to be invited into the clinic – I would suggest conducting a search on all those asthmatics who have been issued more than 6 SABAs in the last 12 months as these indicate that they are poorly controlled (either due to inappropriate medication OR poor inhaler technique).
If you would like any more information regarding setting up your own asthma clinic OR anything related to medicines optimisation in asthma; please get in touch.
