Journal of Medicines Optimisation - Sep 2019

Journal of Medicines Optimisation • Volume 5 • Issue 2 • September 2019 29 Editorial An evaluation of the suitability, feasibility and acceptability of diabetes group consultations in Brigstock Medical Practice Group consultations are planned clinical care with a clinician consulting with a number of patients in a supportive group setting. This approach, which has been introduced by a general practice for patients with Type 2 diabetes, is reported in this edition. Whilst maintaining the total number of patients reviewed, the practice reduced its diabetes clinics from eight three-hour one-to-one clinics a week (a total of 24 hours of clinic time) to two one and a half hour group clinics and one three hour one-to-one clinic, reserved for patients not suitable for a group review (a total of six hours of clinic time). This equates to a saving of 18 hours of clinician time and five half day sessions a week; equivalent to a 0.5 full time clinician post. The group clinics also improved access by freeing up practice nurse and pharmacist appointments in one-to-one clinics and by reducing waiting times for diabetes reviews from six weeks to two weeks. Clinical audit of a sample of 65 patients with at least two separate follow- ups over six months found that 70% had improved HBA1c, 61% had improved blood pressure control and 10% had lost weight. Patients self- reported an increased knowledge of their condition after group clinics and there was a high level of satisfaction with the experience. The group discussion encouraged patients to ask more meaningful questions about their medications. This including discussion about the risks, benefits and consequences of starting new medication as well as issues involved with taking a combination of medications or with stopping medication. These are impressive results and it might be expected that the concept of group consultations will be an increasing feature of health care that will be extended to other therapeutic conditions. It is important that clinical pharmacists are aware of such developments locally and participate as appropriate in the process to ensure that opportunities for optimising the use of medicines are maximised. Practice-based pharmacists will be particularly well placed to do this if their GP practice is running or planning group consultations. It will be interesting to hear about the experiences and contributions made by pharmacists in this area. Evaluation of the clinical and cost effectiveness of a standardised protocol for infliximab dosing in adult inflammatory bowel disease. A patient’s weight is used to determine the dose to be given of infliximab, a monoclonal antibody used in inflammatory bowel disease. This can, however, lead to wastage if it proves necessary to open a vial but then use only part of the contents to make up the calculated dose. An article in this edition outlines the development of a dose banding protocol for infliximab, based on dose banding principles established in chemotherapy in which doses were ‘capped’ where less than 6% of an additional vial would otherwise be given. Data was collected on all adult patients prescribed infliximab for inflammatory bowel disease at University Hospitals Bristol over a nine month period and a total of 86 patients were included - 29 patients were using the standardised protocol and 57 were dosed by exact weight. In the capped arm, 76% had a good response and 24% had a poor response. In the ‘uncapped’ arm, 77% had a good response and 23% had a poor response. It was concluded that there was no significant difference between patients whose treatment was ‘capped’ compared to those who were ‘uncapped’. In the ‘capped’ group a saving of approximately 6.5 vials per annum per patient was made, equivalent to a saving of £23,000 per annum for the 29 patients involved. The findings are certainly encouraging but it would be good to collate date on clinical outcomes for a wider population. Pharmacists involved with the provision of infliximab to adults with inflammatory bowel disease will no doubt have this in mind. Patient satisfaction of homecare services to people living with HIV. It is good practice to assess the level of satisfaction with a service that is being provided by seeking the views of the users of that service. This has been done for a homecare service provided to people with HIV who are prescribed antiretroviral therapy. The survey was conducted by issuing a printed questionnaire to 184 patients attending an HIV clinic. The questionnaire was completed in the clinic by the attendees. Most respondents were satisfied with the homecare service but aspects for improvement, such as knowing how to access a helpline or how to make a complaint, were identified. The latter is important in the context of becoming aware of any issues that need to be addressed. Recommendations are made on how to improve communications e.g. by the use of telephone or text messaging. The questionnaire used in the survey is reproduced in the article. Whilst this was utilised for a specific service to patients with HIV, it will be of interest to those who wish to evaluate homecare services generally. HYPERLINKS References and other resource material as appropriate can be accessed directly via hyperlinks in the Journal. SUBSCRIPTION The JoMO is free of charge to health professionals working for the NHS. To obtain a subscription, please go to an d click on the ‘PM Journals’ tab where subscription rates can be found. 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