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In depth: Realising pharmacy's potential

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In depth: Realising pharmacy's potential

New research suggests that a community pharmacy service for older patients taking multiple medicines leads to better health outcomes and significant cost savings.

The national roll-out of a community pharmacy service for older patients taking multiple medicines could save the NHS in England nearly £36m in reduced prescribing costs and hospital admissions, and has the potential to save almost £34m more in hospital stays by decreasing fall-related fractures.

This was the conclusion reached by the authors of the Four Or More Medicines (FOMM) study evaluation, published this month in the International Journal of Pharmacy Practice. The research was based on 25 pharmacies in Wigan, which registered 620 patients taking between five and nine medicines and, where appropriate, suggested changes in their drug therapy that could help to reduce the risk of falls. 

During the six-month project, 142 recommendations were made to prescribers, many of which concerned the potentially inappropriate use of NSAIDs or proton pump inhibitors, or duplication of therapy, although some interventions related to initiation of a new therapy such as asthma medication or a bisphosphonate.

Practical and lifestyle issues were also addressed, with study participants offered advice on a range of topics, including weight management, smoking and alcohol use. Follow-up revealed a significant decrease in the number of falls, and a substantial increase in medication adherence and quality of life.

Risk of falls was reduced

 

Positive difference Royal Pharmaceutical Society English Pharmacy Board member Sultan Dajani says the research illustrates the positive difference community pharmacy could make, over and above benefits to the NHS and patients.

“This research also shows that our skills as experts in medicines means we should be involved in more care pathways; places greater emphasis on information sharing and integrating more with social care; calls for more pharmacist prescribing; and to protect access to pharmacists in all sectors,” he says. Despite this, Claire Anderson, professor of social pharmacy at Nottingham University and also a RPS English Pharmacy Board member, says that more work is needed.

“The main criticism of this project, as the authors acknowledge, is that it is a small, unpowered, before-andafter analysis and not a trial. So we do not know the influence of external factors, such as GP or specialist visits or seasonal variation on the project’s outcomes.

“A further limitation of this study was that it was not powered to detect significant differences in outcomes at the outset. It would now be good to use these findings as the basis to conduct a full randomised controlled trial of the service, including a health economic assessment,” she adds.

The project was conducted by Community Pharmacy Future (CPF), a collaboration between Boots UK, the Cooperative Pharmacy group (now Well), LloydsPharmacy and Rowlands, which aims to provide robust evidence of the economic and patient benefits achievable by community pharmacy services through independent analysis of findings by academics at the University of East Anglia and subsequent publication in peer-reviewed journals.

The Department of Health, NHS Employers, PSNC, independent pharmacies and GPs are all represented on CPF’s steering group. A second CPF initiative based around chronic obstructive pulmonary disease has also shown promise, with pharmacies in the Wirral screening 238 patients (135 of whom were identified to be at risk of the lung disorder) and supporting over 300 patients.

Six-month results revealed better medicines adherence and quality of life, and reduced use of NHS resources. A national roll-out of the service across England could see NHS savings of over £120m, plus more than £86m disease-related cost savings as a result of helping people to quit smoking, CPF has said.

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