Challenges and Opportunities for Respiratory Medicines Optimisation in Primary Care

Medicines optimisation in respiratory medicine includes several aspects; with the most important being confirmation of correct diagnosis. The National Asthma and COPD Welsh primary care audit published in 2017 concluded that there were several inconsistencies with the diagnosis of both asthma and COPD. Using nationally available databases, pharmacists can identify high risk patients to review diagnoses, treatment and confounding co-morbidities to optimise management. Adherence to inhaled therapies is known to be poor but identification of this and discussing the barriers to adherence can help influence control. This may help not only respiratory care, but also management of other long term conditions. The role of the pharmacist here is of upmost importance in providing excellent, holistic care. This in turn, with good inhaler technique, can improve symptom burden, exacerbations and improve patient quality of life. Reduced healthcare utilisation will not only make medication cost savings but also indirect cost savings to the health economy. 

Hetal Dhruve is a specialist respiratory pharmacist with experience of working across the interface in primary, secondary and tertiary care. She has just started a PhD at Guy's and St Thomas' NHS Foundation Trust, with a focus on distinguishing between difficult and severe asthma in primary care. Additionally, she is the clinical lead at City and Hackney CCG, supporting accurate diagnosis, review and treatment for patients with asthma and COPD. She has a particular interest in adherence and influencing and supporting change of behaviour to improve symptom control. Additionally, she is an honorary lecturer at the University College London and teaches at the East of England NHS pharmacist pre-registration training scheme. She has published articles in peer reviewed journals and presented her work at national conferences.