DIABETES
DO WE HAVE AN NHS HEALTH SERVICE OR AN ILLNESS SERVICE? THIS IS ONE OF THE QUESTIONS THE SCOTTISH PARLIAMENT’S HEALTH AND SPORT COMMITTEE HAS BEEN KEEPING US BUSY WITH AS THEY EXPLORE THE WHOLE CONCEPT OF PREVENTION.
THE ROLE OF THE PHARMACIST IN TREATING DIABETES T
by Aileen Bryson MRPharmS Practice & Policy Lead, Royal Pharmaceutical Society in Scotland
he Committee approaching our professional body requesting evidence on where pharmacists can play a part has been a great opportunity to showcase the expertise of our members and inform politicians on the breadth of pharmacy practice. We really appreciate our members from the specialist groups who both contributed to our responses and appeared before the committee.
In our responses, a key theme has emerged – a lot of excellent practice is already taking place but there is so much more that the pharmacy profession could do. The 2014 ‘Diabetes Implementation Plan’ has already made a difference, but there are still over 276,000 people in Scotland living with diabetes and a further 500,000 at high risk of
developing Type 2 diabetes.
The medicines burden in diabetes is signifi cant (eight per cent of total cost of medicines in primary care) and carries both individual and societal fi nancial costs – the fact that Type 2 is preventable makes the statistics even more shocking. This is surely one of the key areas where prevention should be a public health priority.
We know that early diagnosis of diabetes can signifi cantly reduce the risk of developing complications, as it allows people to receive the support they need to manage their condition. Community pharmacy has an opportunity to proactively screen and identify people with diabetes, referring people on to the appropriate health professional when necessary.
diabetes clinic involving a GP with a specialist interest in diabetes and a nurse.
Patients due their annual review are invited to attend an open-access clinic for bloods prior to their appointment, so that their results are available and they are encouraged to access them via the ‘MyDiabetesMyWay’ website.
Julie Finneran, community pharmacist and pharmacist prescriber at Craigmillar Medical Group in Edinburgh, works in a weekly
10 - SCOTTISH PHARMACIST
On review day they meet with the practice nurse for lifestyle advice and are then referred to Julie for a medicines review and a discussion about their diabetes results and treatment options.
As Julie also runs another prescribing clinic within the surgery for hypertension and cardiovascular
The RPS in Scotland’s long-term conditions policy1
outlines the essential
role pharmacists have in preventing, treating and managing long-term conditions. We know that up to 50 per cent of medicines are not taken as prescribed and that 61,000 unplanned hospital admissions in Scotland every year are due to medicines. If we could prevent even a small percentage of these by improving pharmaceutical care, then the rewards would be great in terms of quality of life, patient outcomes and reducing the fi nancial burden on the NHS. In speaking to politicians we deliver the message that where there are medicines there must be pharmacists, both at strategic planning tables and at the front line.
Pharmacists and their teams in all sectors are ideally placed to support
risk assessment, she is able to alter their hypertension medication and book them in for a monthly blood pressure (BP) review if needed. She can provide a surgery meter for home blood pressure monitoring if a patient isn’t diagnosed with hypertension or a ‘Florence’ project BP meter, which allows a patient to text their BP results to the surgery on a daily to six-monthly ongoing basis.
After seeing her, the patient sees the GP, who does a foot check, fi nalises changes to the diabetes treatment and deals with any other identifi ed medical issues. If changes are made to the patient’s diabetes treatment, they are recalled to Julie or the nurse at three-monthly intervals until good
lifestyle interventions. Smoking cessation, CMS consultations and OTC purchasing are opportunities for wider discussions. Cigarette smoking is an established risk factor for Type 2 diabetes and aggravates insulin resistance in people with a diagnosis of Type 2 diabetes.
Often community pharmacists are the control is achieved.
Patients welcome the opportunity to discuss medication issues with the pharmacist. As Julie also works in the community pharmacy, she is also seen as available to them at other times for advice. She can provide glucometers and demonstrate their use to the patient or their family. She often see patients in the pharmacy when they attend for minor ailment treatment or to collect prescriptions and this provides a good opportunity to follow up with patients between formal appointments. Having now been involved with the diabetes clinic for about 18 months, she is fi nding it a satisfying and evolving role.
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