Matching the inhaler to the patient in COPD

Selecting the most appropriate inhalation device from the wide range available is essential for the successful management of patients with chronic obstructive pulmonary disease. Although choice is good for healthcare professionals, knowing which inhaler to prescribe is a complex consideration. Among the key factors to consider are quality of disease control, inhaler technique, inhaler resistance and inspiratory flow, inhaler design and mechanisms of drug delivery, insurance and reimbursement restrictions, and environmental impact. In this article, we offer a simple, practical tool that brings together all these factors and includes hyperlinks to other published resources from the United Kingdom, Belgium, and The Netherlands

The Importance of Self-Management in the Context of Personalized Care in COPD

Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis

Community Pharmacist interventions and improved COPD management

Attar-Zadeh D, Guirguis A, Heading CE, Shah S, Shah U, and Bancroft S, 'Community Pharmacist interventions and improved COPD management'. Paper presented at the 2016 Primary Care Respiratory Society UK (PCRS-UK) Annual Conference: Fit for the Future—A Holistic Approach to Respiratory Carenpj Primary Care Respiratory Medicine, 14-15 October 2016, Telford, UK. Meeting Abstracts available online at npj Primary Care Respiratory Medicine (2016) 26, 16077; doi:10.1038/npjpcrm.2016.77; published online 12 October 2016 Published in partnership with Primary Care Respiratory Society UK.Outline: Community pharmacists are well placed to help the management of patients with long-term conditions such as COPD. Outline of problem: Many factors can prevent optimal care for COPD patients; some can be addressed within a pharmacy setting by improving patient understanding of how their condition can be managed.Non peer reviewedFinal Accepted Versio

Ethnic disparities in the uptake of pharmacy services

This is a letter to the editor of The Pharmaceutical Journal regarding results of an audit undertaken over London North West London. Results of the audit showed racial disparities in the uptake of pharmacy services. This audit comes in line with the recommendations of the Prime Minister to reveal racial disparities and help end injustices and hence, a letter was written to the editor.Non peer reviewedFinal Accepted Versio

Building capacity to support smoking cessation amongst Family Physicians in Romania: The Challenges of VBA in Primary Care Practice

Introduction Romania has a population of 19.5 million. Smoking rates are 37% men and 16.7% women. According to the WHO, 77% of all deaths in 2008 were caused by diseases for which tobacco smoking is the main risk factor. 1 Family Physicians (FPs) have regular and ongoing contact with their patients, therefore they have a unique opportunity to address smoking cessation (SC) efforts.The overall goal is to build capacity to support SC amongst FPs, aiming to improve the health outcomes of patients with tobacco dependence by increasing the number of quit attempts and successful quits. Material and Methods Selection of 15-20 teachers in family medicine interested in SC; adapting and developing a teaching curriculum in accordance with the agreed content but suited to local needs: lack of specialized SC services 2 required Very Brief Advice PLUS (VBA+pharmacological treatment+behavioural support); supporting these teachers in delivering workshops to local FPs; offering to taught FPs a pattern of supporting system for monitoring smokers and SC attempts; adapting and developing a model of educational evaluation to monitor and report progress and outcomes. 3 Results This is an ongoing project using a “cascade” approach. At the moment there are: 4 participants in the IPCRG international teachers’ workshop (1stlevel) and 32 participants in the in-country teaching other teachers (2 nd level); the 3 rd level has begun and will continue by August 2018. The estimated participant and beneficiary numbers are 250 FPs taught and 43,000 patients. Conclusions Building capacity to support SC amongst FPs in Romania using the standardisation of Ask and Advise methods, and adaptation of Act to the national context might increase quit attempts and the number of successful quits when delivered at primary care level. Funding The project is part of the International Primary Care Respiratory Group Teach the Teacher Programme “Capacity Building - Teaching the teachers of primary healthcare professionals to treat tobacco dependence” and founded by a Global Bridges grant

Healthcare costs associated with short-acting β2-agonists in asthma: observational UK SABINA study

Background: Poor asthma control is associated with high short-acting β2-agonist (SABA) use. Aim: To assess asthma-related healthcare resource utilisation (HCRU) and medication costs associated with high versus low SABA prescriptions in the UK. Design & setting: Analysis of SABINA I (SABA use IN Asthma I), a retrospective longitudinal study using UK electronic health records (Clinical Practice Research Datalink GOLD 2008−2019 and Hospital Episode Statistics database). Method: Eligible patients were ≥12 years old with SABA prescriptions in the past year. SABA prescriptions (number of canisters per year) were defined as high (≥3) or low (1–2). Association of SABA prescriptions with HCRU was assessed by negative binominal model adjusted for covariates. The UK unit costs from the NHS were applied to estimate total healthcare costs (2020). Medication costs were based on the annual average number of canisters per year per patient. Results: Overall, 186 061 patients with SABA prescriptions were included, of whom 51% were prescribed high SABA. Total annual average costs (HCRU and medication) were 52% higher in the high SABA group versus the low SABA group (£2 256 091 per 1000 patients/year versus £1 480 640 per 1000 patients/year). Medication costs accounted for the majority of asthma-related costs. Across both groups, most HCRU costs were for non–exacerbation-related primary care or hospital outpatient visits. The annual average HCRU cost difference for high SABA versus low SABA was the greatest for hospitalisations (+230%; £15 521 per 1000 patients/year versus £4697 per 1000 patients/year) and exacerbation-related primary care visits (+162%; £18 770 per 1000 patients/year versus £7160 per 1000 patients/year). Asthma-related HCRU extrapolated to the broader UK asthma population was £108.5 million per year higher with high SABA versus low SABA. Conclusion: High SABA versus low SABA prescriptions are associated with higher asthma-related HCRU costs