Medicines Optimisation SE London asthma and COPD guidelines Finlay Royle Senior Clinical Commissioning Pharmacist Lambeth CCG
Medicines Optimisation Key theme: Quality, Safety and Medicines Waste
Medicines are the most common therapeutic intervention in healthcare, but their use is often suboptimal for a variety of reasons and this can lead to medicines not being used as intended and ‘waste’ in the health economy.
Asthma pyramid outcomes for Lambeth CCG September 2015 against May 2016 The following metrics would be expected to decrease over time: Proportion of patients issued more than 6 prescriptions of short-acting Beta-agonist inhalers Proportion of patients at Step 4 (treatment with high-dose inhaled steroid) The following metrics would be expected to increase over time: Quit Smoking Treatment (in smokers) Carbon monoxide check Asthma action plan issued Inhaled steroid adherence check Spacer issued Very brief advice (smoking cessation) Inhaler technique check These metrics were developed by a panel of asthma and respiratory experts alongside generalists in Lambeth, Southwark and KHP, to test whether they could measure ‘good quality asthma care’, based upon National Review of asthma deaths and BTS/SIGN guidelines on asthma. The metrics were used to assist individual practices assess their performance against these measures and to address specific issues within the practice. Data will continue to be analysed to determine if further change occurs. Over time, these data should be aligned to asthma admission and outcomes data to see if there is correlation. The biggest changes in Lambeth practices were seen in: issuing of Personalised Asthma Action Plans issuing of spacer devices for those using pressurised Meter Dose Inhalers checking of inhaler technique Areas for improvement identified amongst Lambeth practices: 1. Quit smoking treatment and CO check 2. Inhaler technique checks
Introduce the scheme
SEL Respiratory Guidelines: Management of COPD & Asthma New inhaler treatments available on market: New molecules New combinations New devices Previous guidelines across L&S out of date SE London group set up: Consultants, nurses, pharmacists across SEL Review evidence, safety and value Patient feedback on devices Guidelines for asthma & COPD
SEL Respiratory Guidelines: Management of COPD & Asthma General recommendations: Detect & treat tobacco addiction Branded prescribing Patient adherence / technique check Self-management plans High-dose inhaled steroid – specialist Spacer device for Metered-dose inhalers
Asthma
Asthma – key changes In general practice: Spiromax device for budesonide/formoterol Fostair – Nexthaler / DPI MART therapy Specialist recommendations / step 4: High-strength steroids: Relvar Ellipta, or Flutiform NOT Seretide Fostair (high-strength) Tiotropium (softmist inhaler)
Respiratory – asthma New devices on formulary: DuoResp Spiromax Fostair Nexthaler (& MDI) Easyhalers Lower lid to present dose Open lid to present dose Click to present dose Budesonide + formoterol Beclometasone + formoterol Various drugs Dose counter If cap is opened, dose released, counter decreases Counter only decreases if powder inhaled If clicked, dose released, counter decreases Nexthaler – powder stays in reservoir until inhaled. Ie if opened and then closed, but not inhaled, counter does not decrease and dose remains available in the reservoir. DuoResp Spiromax – dose counter decreases and dose is released every time lid is opened Easyhalers – beclometasone, budesonide, salbutamol and formoterol (separates). Double-clicking before inhaling results in double dosing. Simple click to release the dose. Dose counter
COPD
COPD – key changes In general practice: New LAMA/LABA devices – place in therapy Medicines Optimisation Scheme PR, tobacco addiction and vaccinations Specialist recommendations / step 4: Refer to specialist for triple therapy and/or when patient exacerbates Options for triple therapy
Lower cap to present dose Respiratory – COPD LABA / LAMA devices on formulary: Ultibro Breezhaler Duaklir Genuair Anoro Ellipta Insert capsule, pierce Click to present dose Lower cap to present dose Once daily dosing Twice-daily dosing Visual indicator Audible and visual indicators Ellipta device available for steroid Rx Follow-on from Seebri Breezhaler Follow-on from Eklira Genuair Follow-on from Incruse Ellipta
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