AWARDS
COMMUNITY PHARMACY SERVICE INITIATIVE
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DAVIDSONS CHEMISTS, FORFAR, ANGUS
In Scotland, it is estimated that 50,000 people have been exposed to HCV and at least half of these still remain to be tested for the infection. HCV infection affects 0.7 per cent of the general population, and affects up to 40 per cent of people prescribed Opioid Substitution Therapy (OST).
Until recently, most people receiving treatment for this infection would have been prescribed two main medications: pegylated interferon (a weekly injection) and ribavirin (a capsule or tablet) from a hospital. These medicines had a significant burden of treatment and required intensive monitoring and management. However, the new hepatitis C medications (Direct-Acting Antivirals - DAAs), are available in tablet form, are easier to tolerate, and have shorter treatment courses.
These new health technologies make it possible to cure the infection in over 95 per cent of patients from a community setting. In 2013, initial feasibility work was carried out in a partnership between the University of Dundee and pharmacies. Further extension of this work is now being undertaken through the SuperDOT-C study, which is designed to compare the rate of sustained viral response (SVR) of those patients being treated through the conventional nurse-led pathway with those being treated via the pharmacy-led pathway at twelve weeks post completion of antiviral treatment in OST patients across five sites in NHS Scotland. The cost effectiveness of each of the treatment pathways is also being compared by the study team.
In December 2016, Davidsons Chemists in Forfar, Angus, was contacted by Andrew Radley, Consultant in Public Health Pharmacy for NHS Tayside to ask if they would take part again in the next
phase of development work for the SuperDOT-C study.
‘Although the SuperDOT-C study is not due to report until December 2018,’ says pharmacist, Lauren Clarke, ‘the results from the feasibility work are extremely encouraging. The DOT-C study provided strong evidence that people on OST were more likely to undertake a DBST in a pharmacy and more likely to proceed to treatment. This study showed that only 24 per cent of patients accepted a DBST in the conventional pathway, compared to 36 per cent in the pharmacy- led pathway. So far, everyone who has commenced on treatment in my pharmacy has completed their treatment and received their twelve- week post-treatment viral response.’
‘Lauren agreed to be involved with the SuperDOT-C study from the beginning in December 2016, over and above her duties as Pharmacy Manager at W Davidsons, Forfar,’ says Superdot-C Clinical Trial Coordinator, Lewis Beer. ‘Over this time, Lauren helped test and diagnose over 20 patients for HCV. Of the six patients, who were eligible for treatment against HCV through the study, Lauren and her team have been directly involved in seeing all six through their treatment over twelve weeks of daily-observed therapy (DOT).
‘This has required Lauren to engage with the patients to advise them to take a test and to encourage those patients with HCV antibodies to attend a confirmatory blood test appointment with a nurse. When those results were available, Lauren was responsible for analysing the blood results and assessing the patient’s suitability for treatment based on these results and any concomitant medications. She would then request a prescription from the specialist hepatology pharmacist. Carrying
Lauren Clarke, Davidsons Chemists, Forfar celebrates with Rebecca Cabrejas, Generics Business Manager, Accord Healthcare
out these tasks – in addition to her responsibilities within the pharmacy - makes getting six patients through treatment all the more impressive.
‘Following the completion of treatment, each patient received a second blood test to confirm they had received a cure for HCV and it is due to Lauren’s strong personal relationship with her patients that these patients have not only attended, but have also been excited to receive the results of this test.
‘Patients with HCV are a notoriously difficult group to engage with from a clinical perspective and community pharmacists like Lauren are invaluable at reaching these patients and helping them get the medication they need. This would not be possible without
a community pharmacist they trust and who treats the patients with the utmost respect and empathy.
‘Lauren’s hard work to make this study a success in her pharmacy is greatly appreciated by all of the staff involved in the SuperDOT-C study.’
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