1. YOUR PHARMACY / JOB- TITLE YOUR NAME Respiratory MUR

2.  MURs performed by Community Pharmacy  2 – way discussion

3. A New Era  Integrated health care  Transforming your Care  Breaking down health professional boundaries and moving forward with a joined-up approach  Better patient outcomes

4. What is an MUR? The aim of the service is to achieve a concordant approach to medicine-taking by:  Improving the patient’s knowledge and use of their medicines  Establishing the patient’s actual use, understanding and experience of taking medicines  Identifying, discussing and assisting in the resolution of poor or ineffective use of medicines by the patient  Identifying side-effects and drug interactions that may affect the patient’s adherence  Improving clinical and cost effectiveness of medicines prescribed to patients, thereby reducing the wastage

5. MUR Benefits  Improves adherence to prescribed medication – 50% of patients do not take some element of their medicines as prescribed  Improves health outcomes – a high proportion of hospital re-admissions of older people are as a direct result of poor adherence to medication  Improves quality of life  Encourages or improve self-care and self management of long term conditions  Reduces in wastage of prescribed medication  Enables better collaboration between professions

6. Patient initiated on inhaler  Do you have the time to explain & more importantly show them how to use it?  Do you have a placebo inhaler of each type at hand for this?  Do you send them immediately to the respiratory nurse to show them?  Do you tell them to ask their pharmacist to show them?  Do you tell them to read the instructions on the PIL?

7. What % Patients have correct technique?  2008 study 75% of patients reported they were using their inhaler correctly but when reviewed, only 10% actually demonstrated correct technique.  All of these patients have been supplied with a PIL.  Basheti IA, Armour CL, Bosnic-Anticevich SZ, Reddel HK. Evaluation of a novel educational strategy, including inhaler-based reminder labels, to improve asthma inhaler technique. Patient Educ Couns 2008; 72: 26-33.

8. Examples of incorrect use  Not sitting – or (preferably) standing – upright  Not shaking MDI  Priming Turbohaler horizontally  Inhaling before use instead of exhaling  Chin dropped  Not holding breath after inhaling  Incorrect inspiratory flow rate  S/E prevention – washing mouth out after inhaled steroid

9. Pharmacists Role  2011 study, evaluating the effectiveness of inhaler training by pharmacists - % of patients with optimal inhaler technique rose from 24% before to 79% after a short training session.*  Inhaler technique must be rechecked and education must be reinforced regularly in order to maintain correct technique, as inhaler technique deteriorates again after education  We have the actual device  Complements NOT competes with or replaces what your respiratory nurse does  In-check dial  Paperwork  * Giraud V, Allaert FA, Roche N. Inhaler technique and asthma: Feasibility and acceptability of training by pharmacists Respiratory Medicine (2011) 105, 1815-1822

10. Relevance to GPs  Complex patients at highest risk – especially ‘revolving door’ type needing super management  CPs can’t always identify these. GPs can refer to CP for MUR  What % patients fail to turn up for respiratory nurse appointments?  Part of ICP respiratory care pathway – up to you how you do it locally. Talk to your CPs.  Valuable service already commissioned, but in some areas under utilized  QOF points

11. Positives  Opportunity to address lifestyle issues – smoking, diet, exercise & stress management  Feedback from patients overwhelmingly positive. Majority very grateful after the 15-30 mins the review takes.  One mother reported since her 10 year old daughter had an MUR in June her asthma has been controlled better than it has been in years, as she has been using her inhalers correctly for the first time. Less attacks of asthma & able to reduce Montelukast which had been causing her to sleepwalk. Now significantly less tired in morning too.

12. What else can we do?  ‘The co-ordination of care is where we currently fall short’ Dr Sloan Harper  How can we improve this?  What would you like feedback from CPs on?  How would you like CPs to feedback to you?