Leon O’Hagan – i2i Asthma Award Winning Case Study

Brief summary of the project

I named the project “Banbridge Every Inhaler Checked” After attending the workshops I released that a huge amount of the problems patient have with their asthma treatment is their understanding and technique of inhaler use. I also realized that being the only pharmacist in the surgery it would take me a huge amount of time to assess and identify any technique problems with our 700 registered asthmatic patients – reviewing each one properly would take approx 240hrs! There was also the issue that many patients for whatever reason, very rarely attend the surgery for any review/ contact. But these patients still would have to collect their dispensed medication – so that contact provided an opportunity. In Banbridge there are 5 community pharmacies who I have worked hard to build a collaborative relationship with. I believe that my role in the patient journey does not end with giving them a prescription and sending them out to get it dispensed – so they were receptive when I broached the idea of incorporating their help to assess and identify patients needed for a more focused review. I held an information evening in the surgery attended by the Pharmacists, Pre-reg students and GPs where we discussed the aims of the project and how best to conduct it. At that evening I gave out information from the NRAD report and a pack for each pharmacy of all types of inhaler placebos as well as Asthma Control Test questionnaires, COPD assessment Tests, Peak Flow meters and diaries.

Implementing the ABCDE methodology

Agreed Scope 

We agreed that where possible – any prescription presented to the community pharmacy was an opportunity to discuss and assess inhaler technique – but especially new devices. The pharmacists used the Asthma Control Test template to query how the patient felt they were controlled and also to assess their technique for any issues.

Buy-in 

Local pharmacists and GPs we consulted with to identify their reservations/ issues. As with many areas of healthcare – the time/ resources taken to conduct a review in the community could be problematic. I suggested that the pharmacies could use the time they take doing MURs (Medication Use Reviews) to conduct the assessment at the same time. In that way, the MUR gains value – and the pharmacy are being funded for it.

Conduct Preparation 

I prepared hand-outs for the local pharmacies in the background of the problem outlining the findings from the NRAD report. All were in agreement that it was an important area of work and we should collaborate to achieve the best patient outcomes for the surgery. I also utilised some offers of resources from various respiratory reps (one sponsored Pizza’s for the meeting!) and others contributed as many placebos, training devices as I could store.

Deliver 

The assessments were initially delivered using the ACT or CAT questionnaires / scores as they were well defined metrics that could be READ coded to the patients notes. The community pharmacist would then send these results to the surgery along with a written assessment of the patients use & technique of their inhalers. If the felt the patient would benefit from a peak flow meter and diary they were given one – which I then replaced from my stock.

Evaluate Outcomes

The project is still on-going and receiving good support – though many pharmacies haven’t had as much time as they hoped to assist – we are still receiving information on patients that we wouldn’t have previously otherwise. I have been able to identify those patients whose asthma control is not as well as they hoped (though their prescriptions issued did not always suggest so) and have been in for a full review with a few moved to a more suitable device. Data collection is on-going – but ultimately I hope to show a definitive reduction in hospital admissions by our Asthma patients as well as a reduction in Salbutamol issuing. If successful I hope to approach the local Integrated Care Pathway Board to discuss formal funding for pharmacies to carry out assessments.

Clear and measurable patient / medication-related outcomes

There is already an identified reduction in Salbutamol prescribing and the surgery have been able to increase their QOF points for care of their Asthmatic patients by adding the ACT scores to the patient records. We have also been able to identify patients having issues with their current device and have switched accordingly. For the first 2 months of the project there has been a 5% reduction in Salbutamol issued for the same period in the previous year.

How did the i2i Network help you achieve these outcomes?

The i2i newtork and resources enabled me to structure the project in an appropriate and thoughtful way. This has helped with the buy-in and delivery of the project.