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Case Study Six

 
TREATMENT REVIEW
Level 2 treatment reviews by practice support pharmacists in central Huddersfield PCT

Background
Central Huddersfield PCT identified the prescribing of proton pump inhibitors (PPI) as a priority for improvement as part of its application to become a collaborative MMS pilot site.
 
The number and cost of prescriptions was rising significantly and patients were being continued on treatment doses rather than reduced to maintenance doses for these medicines.
 
Practice support pharmacists accessed clinical notes in GP surgeries to undertake treatment reviews for patients prescribed PPI.

Objectives

  • Introduce a scheme to reduce number of prescriptions for PPIs
  • Review patients' notes and reduce length of time on unnecessary or unwanted treatment
  • Identify patients needing a clinical medication review
  • Improve implementation of national guidance (NICE) and manage expenditure on PPIs

Approach

The PCT offers the therapeutic review service, provided by support pharmacists, to all of its GP surgeries. A prescribing incentive scheme runs in parallel and helps support the scheme.
 
The pharmacist generates a list of patients prescribed a PPI and follows a protocol, agreed with the surgery, to check each patient's clinical notes. This includes a review of the original diagnosis or indication for treatment, the date started, the current dose and the last date that the prescription was collected.
 
Based on the findings, the pharmacist will recommend adjusting the dose, stopping the PPI entirely, changing to a simple antacid or will refer the patient for a clinical medication review with the GP. Any changes are recorded in the patient's notes and a flag set to inform the patient next time that the drug is requested.
 
Pharmacists undertaking reviews receive training which includes therapeutics and working with patients and GPs.

Results

In a practice with 1959 patients, 75 patients on the current repeat medication list were prescribed  PPIs. Of these 43 were identified as being on a treatment rather than maintenance dose and some had never had a review of treatment.
 
In line with current NICE guidelines and standard doses from the British National Formulary, the practice support pharmacist recommended that 36 of the 43 patients could have the dose reduced or  could be changed safely to a simple antacid or the PPI stopped altogether.
 
These recommendations lead to a potential cost saving of over 6,000 each year in this practice or 220,000 for all the surgeries in Huddersfield.
 

Conclusion

A simple intervention scheme, provided by pharmacists with access to the patient's notes, can both improve patient care, identify those in need of in-depth reviews and significantly reduce expenditure, freeing up resources for use in other areas.

Contact Information

Michael Duckworth, Pharmaceutical Adviser, Central Huddersfield  PCT

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