1. South Central Respiratory Project MK Report 10 th October 2011 Nikki Hughes Community Pharmacy Lead NHS Milton keynes

2. What worked well for NHS MK?  Preparation  Information  Communication

3. Background  In MK we prescribe £3m of inhalers annually (estimate)  We know that patients do not use inhalers effectively – wasting much of this spend  This project allowed us to measure the clinical benefit of the pharmacist intervention at dispensing

4. Preparation: we had already ….  Run an audit in hospital COPD clinic - most COPD patients did not use their inhalers correctly  Audited inhaler technique of local HCPs - only 7% could demonstrate correct technique including correct inspiratory flow rate  Run a local pharmacy project - patients are happy to access additional support from their pharmacy  Run training events on inhaler technique for pharmacy teams, GPs, and nurses  Provided In-check dials to all pharmacies and practices in MK  Run a multidisciplinary audit to get pharmacists to check inhaler technique when dispensing

5. Information:  We had not been able to measure the effectiveness of pharmacist intervention  The IoW model used symptom control tests before & after the intervention to do this  ESMAQ reporting tool allowed us to monitor activity & analyse results real time

6. ESMAQ allowed…  The pharmacists could measure the impact of their intervention on patient care  The scoring helped patients understand that better technique made them feel better  The PCT could demonstrate the value of the service to patient care

7. Communication:  Real time analysis meant we could influence the project whilst still underway  Pharmacists could see each other’s activity – this stimulated healthy competition  Open access to results allowed pharmacists to measure themselves against their peers  I could identify & tailor support for slow adopters  I could ask trailblazers for top tips of what worked for them & share these during project

8. Communication contd Early on the GPs reported that patients were claiming that they no longer needed to attend review appointments there as the pharmacist had already reviewed them. I could refute the reports as 24% of the patients pharmacists were accessing had not seen a GP or nurse for over 12 months. The project improved the reach of messages to these people I could refute the reports as 24% of the patients pharmacists were accessing had not seen a GP or nurse for over 12 months. The project improved the reach of messages to these people I could influence pharmacists to remind patients it was even more important to go for GP reviews because improved technique meant that doses should be reviewed I could influence pharmacists to remind patients it was even more important to go for GP reviews because improved technique meant that doses should be reviewed Now 14 patients have been referred into the service by the GP / nurse Now 14 patients have been referred into the service by the GP / nurse

9. Communication…..3  Results have demonstrated that 37 patients (60%) have improved their symptom control during the project.  Where unexpected results happened (sometimes scores got worse..) I could encourage pharmacists to see the bigger picture, this was normal & not to give up.

10. Communication ….4 Results demonstrated improved recruitment to stop smoking support 28% inhaler users were smokers 28% inhaler users were smokers 28% of these smokers accepted referral 28% of these smokers accepted referral A further 4 patients accepted referral at second intervention A further 4 patients accepted referral at second intervention 6 extra 4 week quitters so far 6 extra 4 week quitters so far

11. Communication…..5 Patients love it…. A reluctant recruit said “I didn’t know that – I have learned something today after all. Thank you” Pharmacists love it…. “…another targeted asthma MUR who was suffering oral problems from the preventer inhaler. I suggested using a spacer and some improvements to her technique. She was using a reliever 4 - 5 times a week. Now she rarely uses her reliever and has no oral symptoms. 4 point increase in ACT score! Sometimes you get to make a difference!” Sometimes you get to make a difference!”

12. And the PCT benefits…?  We have developed patient leaflets to be used to highlight individual advice for patients  We will use the “preparation, information & communication” approach again  We are looking at offering a similar structured approach to the other target MUR groups…  We are collecting evidence to persuade PCT to buy ESMAQ next year ….  We will use NMS data (from Pharmabase?) locally to influence change