Devon inhaler use review pilot wins BTS award
Published on: 3rd December 2019 | Updated on: 15th March 2022
A pilot scheme in Plymouth allowing patients to have inhaler use reviews in their local community pharmacies has won an award at the summer British Thoracic Society meeting for Innovation in Service Delivery and/or Education and Training in Respiratory.
Background
The pilot service was set up in response to data highlighting the area’s relatively low prescribing of spacers compared to that of inhalers. It was decided that community pharmacists would deliver targeted consultations to adults who were prescribed inhaled corticosteroids. As well as advice on inhaler use, patients could receive free spacer devices if MDI technique was observed to be poor; the targeted review by the pharmacist ensured that these were supplied and used appropriately. This allowed patients to improve their inhaler technique without an unnecessary trip to the GP for an appointment and a prescription.
A specialist respiratory pharmacist delivered training to community pharmacy teams to ensure that suitable patients were invited for review and that the service was delivered to a high standard.
What did the service involve?
Initially commissioned in March 2018 and involving 20 community pharmacies, the scheme aimed to deliver on four primary objectives:
- Inhaler technique review using the InCheckᵀᴹ device;
- Provision of a spacer if required (without a prescription);
- Inhaler adherence review; and
- Smoking cessation support.
After the original pilot was extended in September 2018, further secondary objectives were added to provide advice on the following:
- COPD rescue packs;
- Vaccination; and
- Pulmonary rehabilitation.
Pharmacists were given the ability to directly refer consenting patients to a pulmonary rehabilitation course via PharmOutcomes, without the need for GP intervention.
What were the results of the project?
| Outcome/ advice to patients | Number | Percentage |
| Rinse mouth after inhalers | 144 | 59.3% |
| Spacer supplied | 93 | 38.3% |
| Smoking cessation support | 52 | 21.4% |
| Discussed low adherence | 45 | 18.5% |
| Flu Vaccination advice | 16 | 6.6% |
| Discussed over ordering medication | 15 | 6.2% |
| Rescue pack advice | 12 | 4.9% |
| Referred to the PR team | 6 | 2.5% |
Tony Perkins, Senior Medicines Optimisation Pharmacist for NHS Devon CCG, commenting on the benefit of the respiratory focused medicines reviews said:
“They offer high-value interventions which are entirely within the remit of community pharmacy, without increasing workload for GPs and nurses.
“We are also using the service to highlight other high-value treatments which community pharmacy is already enabled to offer people with respiratory conditions such as flu vaccination. Some of the highest value treatments in respiratory are smoking cessation, pulmonary rehabilitation, vaccination and appropriate inhaler technique, pharmacy can support patients with all of these”
The ability to opportunistically offer patients an additional inhaler use review (these interventions are not intended to replace patients’ annual clinical reviews with their GP practice) which focuses on inhaler technique, adherence and lifestyle factors meant patients were empowered to self-manage their health and ensure medicines are used to best effect.
Patients who received spacers on the scheme were of the same proportion as those who displayed poor inhaler technique, suggesting that the service has appropriately managed these patients.
Next steps
As a result of this pilot, the British Thoracic Society presented Devon CCG and Devon LPC with an award for their innovative project. The project itself is growing, with more pharmacists to receive training this year.
Further information on the project can be found on the Community Pharmacy England Services Database
