AWARD WINNERS
COMMUNITY PHARMACY SERVICE INITIATIVE ANDERSONS PHARMACY PorTADoWn
ToDAy'S PhArMACISTS hAVE A VITAl rolE To PlAy In SUPPorTIng PATIEnTS lIVIng WITh long-TErM ConDITIonS AnD IMProVIng MEDICInE oPTIMISATIon. AS ThE WInnEr of ThE CoMMUnITy PhArMACy SErVICE InITIATIVE AWArD ClEArly ProVES InTErVEnTIon lEADS To PoSITIVE oUTCoMES
A
s the 'hub' of the community, Judith Dowey, pharmacy manager at Andersons
Pharmacy in Portadown had noticed - as in all areas of northern Ireland - the increasing number of people presenting in the pharmacy with hypertension and hypercholesterolemia. (It's estimated that high blood pressure accounts for more than ten per cent of all visits to gPs.) Judith was naturally concerned about this increase since high blood pressure can lead to diseases such as heart disease, stroke, vascular dementia and chronic kidney disease.
She was also, however, aware that the particular rise in hypertension in those under 50 years of age could potentially be prevented or controlled through lifestyle changes, and felt that pharmacy intervention could, in this instance, be both proactive and beneficial to patients.
Judith is an independent prescribing pharmacist, and in partnership with a local gP practice was able to set up a weekly cardiovascular clinic within the practice. Working closely with the gPs, in conjunction with the pharmacy's own database of patients with hypertension and hypercholesterolemia, Judith was able to establish a clinic to manage the relevant patients within that particular gP practice.
Through the clinic, Judith sought to manage those patients newly diagnosed with hypertension - and
24 - PhArMACy In foCUS
those previously diagnosed - to achieve optimal BP control through both lifestyle and medication as per evidence-based guidelines.
once the clinic was established, Judith then identified a further requirement for the patients. In numerous cases of patients with either new onset of raised BP or of those requiring a dose titration, a referral to the practice nurse was needed in order to have baseline bloods organised and repeat U&Es. So, in September 2015, Judith attended the 3fiveTwo training academy to train as a phlebotomist to add to her prescribing capability.
once she had undergone full training and had received accreditation as a pharmacist phlebotomist, Judith was able to expand the remit of the cardiovascular clinic to be able to provide a one-stop appointment for patients where they could have a cardiovascular review, have their bloods screened (if necessary), or have bloods taken in those circumstances when an increase dose of medication is needed. It also enabled her to take annual bloods for diabetes and chronic kidney disease (CKD) patients. This has been a great benefit to the practice and even more so to the patients.
In those patients with new onset of raised BP, Judith also began actively screening for diabetes through a hbA1c blood, as well as taking a U&E, TfT, lfT, lipid and an annual
SoU for ACr for those patients with CKD.
To date the screening and interventions at the cardiovascular clinic has resulted in the detection of numerous conditions being diagnosed and the following conditions have been detected: Atrial fibrillation through pulse palpation: two patients CKD stage 3: two patients hypertension: twelve patients Type 2 Diabetes: four patients Irregular pulse rhythms: five patients Pre-diabetic patients: eight patients
one hundred per cent of all patients seen were given lifestyle advice (alcohol intake, height, weight BMI, smoking cessation).
Thirty-two patients with a calculated CV risk above ten per cent were commenced on a statin as a primary prevention measure, with baseline lfT and lipids and monitored again accordingly.
Twenty patients were given 24-hour ambulatory BP recording, with a follow-up appointment to discuss result and for screening bloods to be taken.
The economic benefits of Judith’s interventions are clearly obvious. Statistics have shown that, by reducing the blood pressure of the nation as a whole, £850 million of nhS and social care spend could be avoided over ten years.
Also, if just fifteen per cent more people, unaware they have high blood pressure, were diagnosed, £120 million of nhS and social care spend could be avoided over ten years. If another fifteen per cent more people, currently being treated for high blood pressure, controlled it better, a further £120 million of nhS and social care spend could be avoided over ten years.
While the economic statistics are to be welcomed, however, Judith's primary concern was naturally for her patients. To date, the screening and interventions at the cardiovascular clinic have resulted in the detection of numerous conditions being diagnosed. This is not only beneficial to the patients themselves, but also to the local gP practices, which were already experiencing overwhelming workload.
Judith's added ability to work as a phlebotomist also provided another clear example of how pharmacists' prescribing skills and added-value training can provide a service in the community that provides much- needed support for gP practices.
Through the clinic, Judith has established a strong partnership between Andersons Pharmacy and the gP practice, and this clearly shows the vital role that the community pharmacist can play in managing conditions and in consulting with patients.
Judith Dowey, Andersons Pharmacy and Rebecca Cabrejas, Actavis UK
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