DIABETES
nearest available health professional in deprived areas and we know that inequality exists at every level of the patient journey. People on low incomes are one and a half times more likely to develop diabetes than those on an average income, and children growing up in low-income households are three times more likely to be obese than those in high-income households. Social prescribing is something which has been raised and would provide a non-medical option with a person-centred focus. Will pharmacist prescribers be enabled to do this if implemented?
While excellent care is carried out in many areas across Scotland, it is not available everywhere. There is a disparity of care between health boards and between people with Type 1 and Type 2 diabetes in terms of the care processes they receive and their ultimate outcomes. We want to reduce variation and harm and ensure equity of care for all.
The practice examples illustrate how developing the role of the pharmacist in diabetes has positive outcomes on patient care and the wider NHS. Patients have improved access to a healthcare professional with expertise to support them in managing both their diabetes and other long-term conditions. The pharmacist can facilitate appropriate referral to other practitioners. The holistic approach pharmacists provide can encourage patients to take ownership of their own health and wellbeing, improving
their quality of life and encouraging lifestyle changes. The practice benefi ts from an expert to assist with any medicine-related enquiries and to ensure safe, evidence-based and cost- effective prescribing.
Access to health records and sharing of information between health professionals is an essential ingredient in all of this. Pharmacists - wherever they are practising - need to be able to collaborate with their colleagues in other sectors to provide integrated care. We must ensure that pharmacists, with patient consent, have read and write access to the patient’s health record regardless of in which setting care is provided. We have raised this several times and are now beginning to see it addressed in various work streams by Scottish Government. It is a welcome element in ‘Achieving Excellence in Pharmaceutical Care’. We are delighted that the other healthcare professions are echoing our call for this change if we are ever to achieve the transformation in primary care called for.
We are refreshing our long- term conditions policy in light of developments since it was published in 2016. Please get in touch with your ideas and best practice examples regarding pharmacists’ role in prevention and supporting people with diabetes and other long-term conditions by emailing me at aileen.
bryson@rpharms.com. •
the Diabetes Outpatient department of the Western General Hospital.
It was set up in response to a need to improve diabetic patients’ cardiovascular risk factors as they are at much higher risk of developing or worsening of cardiovascular disease than the general population (eg, stroke, MI, cardiac failure) and suffer from many of the complications of diabetes as they grow older (eg, impaired renal function, eyesight deterioration.)
Alison Cockburn, Lead Diabetes Cardiovascular Risk Pharmacist, works at the Diabetes Cardiovascular Risk service, which was established approximately ten years ago within
The weekly clinic treats patients with hypertension and/or adverse lipid profi les. Most patients achieve target blood pressures and cholesterol levels within three to four months. Signifi cant reductions in patients’
Susan Macfarlane, Pharmacist Prescriber at Craigshill Health Centre, Livingston provides medication reviews for patients with Type 2 diabetes mellitus working alongside the GP as part of the General Practice team.
The weekly clinic, initially set up in 2006 with Susan as a supplementary prescriber, focuses on patients with Type 2 diabetes who are able to attend the health centre and who, jointly with the GP, have agreed to be ‘managed’ by the pharmacist. This clinic has continued to develop, particularly since 2009 when Susan qualifi ed as an independent prescriber.
Her main focus is to implement national treatment guidelines to achieve target reductions in HbA1c, blood pressure and cholesterol in patients with Type 2 diabetes and improve patient compliance and knowledge about their medications.
She also encourages and supports patients to adopt a healthy lifestyle through provision of advice regarding their diet, exercise, smoking and alcohol consumption.
The GP and Susan’s clinics run simultaneously, allowing time for pre- and post-clinic discussion as required. Patients are identifi ed through the diabetic recall system and invited to the clinic, with bloods taken the week before to facilitate constructive discussion at the
blood pressures resulting in greatly reduced risk of cardiovascular disease are achieved, along with improved patient compliance with their medications.
In addition, healthy lifestyle advice including improvements in diet, exercise levels and smoking cessation are provided.
Due to its success, the service has been extended to the Royal Infi rmary and St. John’s Hospital diabetic outpatient clinics and a specifi c service for patients of ethnic minority origin established.
As a pharmacist, Alison focuses on reviewing and optimising patients’ medications, ensuring that an accurate medication history is taken
appointment.
Within the consultation, relevant biochemical and haematological results are reviewed/BP measurement/foot assessment for pulses and vibration. All patients’ medications are reviewed, concordance and counselling issues identifi ed discussed and a shared agreed management plan formulated. Counselling is given both verbally and written to the patient.
Susan arranges review appointments for blood or BP monitoring if necessary with the most appropriate health care professional and determines diabetic review appointments as required.
Patients can also contact the GP practice and leave a message for Susan should they require any further pharmaceutical help and advice or they can access their local community pharmacy.
at the fi rst appointment and any changes to patients’ medication are communicated to their GP to facilitate seamless care between the hospital diabetes clinics and primary care.
Patients’ compliance with their medication is improved through discussion regarding the importance of taking their medications, use of compliance aids and liaison with their GP or community pharmacist as appropriate.
A recent survey of patients’ experience of the clinics showed that they greatly appreciated attending and felt their level of knowledge about their diabetes and hypertension had greatly improved.
1 “Improving Care for People with Long Term Conditions”, Royal Pharmaceutical Society in Scotland, December 2016:
http://rphar.ms/LTCScotland, accessed 14/03/18.
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