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Role of the pharmacist

the hospital pharmacy when they get outpatient prescriptions dispensed. It is worth noting that inflammatory arthritides and DMARDs for treating them are not included in the New Medicines Service, which was introduced to community pharmacies in late 2011.6 Once patients are stabilised on DMARD therapy, then their general practitioner (GP) may be asked to take over prescribing and monitoring the patient in accordance with any shared-care guidelines that may be in place locally. Supply is then likely to be made via community pharmacy. Community pharmacy contractors are currently contracted to deliver Medicines Use Reviews (MURs) and receive numeration of £28 per review, up to a limit of 400 reviews per year.7

Product Characteristics, or in the British National Formulary; as an example, many patients with PsA are likely to be taking NSAIDs such as naproxen in combination with methotrexate. There is a theoretical risk to the patient, as the NSAID may cause impaired renal function leading to decreased methotrexate excretion and potential toxicity, though in practice the combination of NSAID + methotrexate is

the patient volunteers this information. Eventually, community pharmacist access to the Summary Care Record may overcome this difficulty if information about biologic use is included within the SCR.

There are also other, less structured, opportunities for community pharmacists to support patients with PsA; these patients may seek advice for treating

“There is evidence that compliance with, and adherence to, treatment is generally poor in patients with rheumatic diseases ”

The MUR is intended to

be a review of compliance/adherence rather than a full clinical review, with the aim of finding solutions to problems that may be preventing the patient from taking their medication as prescribed. Clearly this is an opportunity for pharmacists to support patients with PsA in taking their medicines as intended – for example, an MUR may identify that a patient experiences nausea following each dose of methotrexate and needs to be referred back to their rheumatologist to consider alternative treatments. However, pharmacists do need to ensure they are aware of relevant guidelines and local practice, as these may differ somewhat from the manufacturer’s

24 recommendations in the Summary of

widely used without consequence in patients who have normal renal function. However, patients will sometimes report being told to avoid this combination by a community pharmacist, based on information in standard reference sources or the interaction-checking algorithm in the pharmacy Patient Medication Record system.

Patients being treated with biologics represent a further challenge. These medications can only be prescribed by an appropriate specialist, and in the UK are frequently supplied to patients either via homecare, or, in the case of infliximab, as an infusion administered in an appropriate daycase setting. The biologic may not appear as a medication on the patient’s GP record and the community pharmacy is unlikely to be aware that their patient is taking this medication, unless

psoriasis with over-the-counter products, or may want to know what they can take alongside their PsA medication to treat other conditions; in these situations pharmacists can reinforce key messages such as the need to omit biologics when unwell with an infection. Following a 2006 National Patient Safety Agency alert, all patients prescribed methotrexate for any inflammatory condition (including PsA) should have a patient-held dose and monitoring record, which should be checked by the pharmacy when they have prescriptions for methotrexate dispensed.8

What about hospital pharmacists? Some of the points for community pharmacy will be relevant to hospital pharmacists but there is also the potential for pharmacists to take on specialist roles and have greater involvement in the care

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