PM Healthcare - Summer 2022

PM Healthcare Journal 17 PM Healthcare Journal This article contains promotional content and the views expressed are those of the author. It is sponsored by Thornton and Ross, part of the Stada Group. Ayrshire & Arran Health Board – A respiratory case study Summary This project, initiated by Ayrshire & Arran Health Board, facilitated a change in medication to Thornton & Ross’s (part of the STADA Group) Fixkoh Airmaster 1 (Salmeterol/Fluticasone) dry powder inhaler range for over 900 patients, achieving a 90% success rate (against a target of 75%) and saving the Health Board approximately £100,000 per year (the annualised saving at the conclusion of the project). In this article, we explain why the project was undertaken, how it was run and the benefits and lessons that can be learnt. As part of the Health Board’s commitment to achieve beneficial cost savings, David Noon (Senior Pharmacist within the Ayrshire & Arran primary care team and a member of the Ayrshire & Arran Health Board Respiratory Working Group), led an initiative to progress patients using an inhaler for the treatment of asthma and COPD to Thornton & Ross’s Fixkoh Airmaster 1 dry powder inhaler. Whereas previously the Health Board was not inclined to move patients in this cohort due to lack of choice of equivalent strengths of alternative inhalers, the Thornton & Ross product facilitated the possibility of moving a significant number to a single device type across all three strengths of the inhaler range (mcg: Salmeterol/Fluticasone – 50/100, 50/250, 50/500). An important factor in the decision to proceed was the Health Board’s commitment to pharmacotherapy, which prioritises workforce issues and support for GP workloads, as well as achieving cost efficiencies. The Thornton & Ross product was seen by the Health Board as supportive of this objective due to potential cost savings, coupled with relatively low patient numbers which would not significantly impact on the existing pharmacotherapy workload. Initial approval was obtained from the lead pharmacist within primary care at the Health Board, who also leads the Respiratory Working Group. David Noon was the overall project lead, with designated team leads taking responsibility for each of the three localities within the Health Board (North, South, and East). This team structure ensured that a lead in each area would assume responsibility for and oversee the implementation of the project. Analysts at the Health Board were able to identify the patient group, which contained a relatively low number of users (some 900). A PRISMS search was initially used to gather approximate patient information for the full Health Board. Then, at the GP practice level, an EMISWeb search was conducted to obtain the latest patient data. Having identified the patient group, the Health Board then determined the GP practices with the highest number of inhaler users out of the 55 practices in its geography, so that resources and support could be properly targeted. This initial phase was instrumental in determining team staffing levels in GP practices, so that adjustments could be made where necessary to help implement the project. Current respiratory patients were assessed by reference to their GP patient notes. Any patients who had reported recent exacerbation was put on hold until they had been exacerbation- free for three months and those overdue a respiratory review were also highlighted to the practice. In each GP practice, a lead pharmacist took overall responsibility for ensuring the successful completion of the project, with delivery led by technicians and support workers responsible for patient identification and the background analysis to determine appropriateness. When this stage of the project was completed, the lead pharmacist authorised the transition to the new product. The total staff compliment involved in the project was around 150, split between pharmacists, pharmacy technicians and support workers. Ongoing feedback from the practice to the Health Board was provided by spreadsheet, showing the total number of patients identified, total patients revised and the achieved savings. Demonstration inhalers were offered to patients and also provided to community pharmacies for patient assistance. Few objections were received from patients, partly because the devices used were similar, though for a small number of patients some dexterity issues with the new device were identified and addressed. A key part of achieving the cooperation of patients was to ensure the rationale for change was properly communicated. Cost savings alone may not resonate too strongly, but among patients there is a realisation, post-Covid, that resources and staff in the NHS are under considerable pressure and therefore economies are both necessary and justified. It was important to understand patient concerns relating to a change in medication, but also to properly explain the rationale for change. Patients were able to remain on their existing medication if they chose to do so, and there were some circumstances where the proposal would have been inappropriate, for example in the case of a patient who was receiving palliative care or had experienced a bereavement or similar trauma. A further consideration was the impact of change on the Health Board’s commitment to reducing its carbon footprint, where possible. However, as the move was from one dry powder inhaler to another, there was no significant environmental impact. This might not have been the case if the change were to an MDI (metered dose inhaler) product, which contains a propellant. The success of the project depended upon the agreement of a realistic timeline – some four to five months from initiation. A long lead-in allowed for problems to be anticipated in advance, for example addressing staffing levels in practices to ensure the project could be delivered to agreed timelines. By working towards an agreed go-live date, everyone involved could be appraised of the same information at the same time. This allowed sufficient time to ensure that a significant number of patients were successfully transitioned (around 90%). With a shorter lead-in time, the expected conversion rate would be significantly lower. Main learnings from project: ● Careful planning from the outset was essential, as was the agreement of a set date for commencement ● Realistic timelines needed to be agreed, allowing all stakeholders (including patients) to be identified, involved and informed ● Goals and objectives were clearly defined and agreed (e.g. what will success look like? How will outcomes be measured?) ● Both healthcare professionals and patients knew where to go for information and to have questions answered ● Support levels were agreed ● Stock levels needed to be sufficient to ensure that the project was properly resourced ● Stocks of the previous product needed to be run down, not wasted (for example, patients were not to be progressed mid-prescription) ● Managing internal and external meetings. Prescribing information can be found on the last page of this article. Prescribing information can be found on the last page of this article. SPONSORED ARTICLE 16