Services Database Lung Health Service Pilot

The pilot aims to improve the diagnosis of lung cancer and other lung abnormalities in Doncaster by:

• detecting symptomatic lung cancer earlier;
• reducing the number of people who present at accident and emergency with advanced lung cancer;
• diagnose previously undetected lung abnormalities e.g. COPD (Chronic Obstructive Pulmonary Disease) other than cancer; and
• to test the pharmacist direct referral pathway over a significant period of time (12 months).

The first point of contact in the pathway is the Medicines Counter Assistant (MCA) in the pharmacy whose role is to identify individuals visiting the pharmacy who may meet the inclusion criteria for the “Lung Health Service”. To help MCAs to spot pharmacy customers who may meet the criteria on further questions, a detail aid has been developed.

A person referred to the pharmacist by a MCA then has a confidential consultation to ascertain whether they meet the criteria for referral to the local acute trust for chest x-ray, or should instead be advised to see their GP.

For the pharmacist to refer someone directly for chest x-ray (pathway A) they must be a current or former smoker aged over 40 and have one of the following symptoms not explained by obvious causes such as current lower respiratory tract infection, known heart failure or cancer etc:

• Cough for three weeks or more;
• Fatigue;
• Shortness of breath;
• Chest pain;
• Weight loss;
• Appetite loss;
• Coughing up blood (haemoptysis); or
• Persistent or recurrent chest infections.

However, if a patient has had a chest x-ray within the last month, then they are advised to visit their GP (pathway B).

A copy of the results of the chest x-ray (radiology report) will be sent to both the GP and the referring pharmacist. Follow-up of patients who have been referred for a chest x-ray by their pharmacist remains with their GP and/or the chest physicians at the local trust (as appropriate). All abnormalities are automatically picked up by the chest physicians as per the local pathway.

All participating pharmacists will have

• skills around ‘sensitively sharing information’;
• reviewed the lung cancer awareness training slides from January 2015 ( See LPC website);
• received training on the signs and symptoms for referral which will include - respiratory chest symptoms from the Local Lung Cancer MDT lead from DBHFT in July 2015; and
• attended IRMER training, Understanding the Implications of Ionising Radiation provided by DBHFT and hold an accreditation certificate.