Anticoagulation: a new role for community pharmacy?
A community pharmacy scheme in Wessex hopes to improve patients’ adherence to anticoagulants by offering more pharmacist support
30 April 2018, by Siobhan Chan
Community pharmacies in Wessex are hoping to improve anticoagulation adherence rates by offering more pharmacist support to patients that have just been prescribed drugs.
Their programme makes better use of the New Medicine Service (NMS) scheme, a national service funded by NHS England that has been shown to improve patient adherence by 10%.
BHF analysis has found that around 16,000 strokes in the UK could be prevented over the next three years if everyone with AF was diagnosed and treated appropriately with anticoagulants, and adhered to them.
But adherence for drugs like anticoagulants can be low. Only 16% of patients who are prescribed a new medicine feel that they have enough information about their medication, and take it as prescribed, with no problems1.
The Wessex pharmacy programme aims to support patients to take their medication by using pharmacists as a source of information and support, particularly on how to manage side-effects like bleeding. This is thought to be the main reason that patients are put off.
“Discussing anticoagulants with patients who have just prescribed them for the first time has been shown to increase adherence rates,” says Sharron Gordon, pharmacist consultant and AF Clinical Lead at Wessex Academic Health Science Network, who led the scheme.
“Patients only remember about half of what they’re told in a consultation – if they’ve just received a diagnosis, they might not be in the right frame of mind to listen,” she says. “Speaking to a pharmacist a few days later could make all the difference to their understanding of their medication, and their ability to stick with it.”
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New Medicine Service scheme
Under the New Medicine Service programme, pharmacists discuss a new prescription with patients to improve their understanding of the drug and how to manage potential problems.
Awareness of the scheme is low among the public and primary care professionals, so the Wessex scheme has boosted its profile by encouraging GPs to prompt patients to discuss their anticoagulant prescription in a pharmacy consultation.
Across 10 Wessex clinical commissioning groups, GPs, and other prescribers, are encouraged to ‘refer to pharmacy’ by using referral postcards or adding stickers, stamps or electronic notes to new anticoagulant prescriptions that encourage patients to speak to their pharmacist.
Patients who speak to their pharmacist about their medication are 10% more likely to adhere to their medications, an evaluation of the NMS has found.
Pharmacists in Wessex have also received more training on how to explain the link between an arrhythmia and the increased chance of stroke. This also includes making it clearer that the medication won’t cause the patient’s palpitations to stop and informing them about signs of bleeding for which they may need to seek immediate medical treatment.
The number of patients seeking out a consultation with their pharmacist about anticoagulants and antiplatelets has increased by 5% in Wessex over the last year as a result of this program , which Gordon believes is reducing strokes and preventing bleeds in people who aren’t taking their medication appropriately.
Although 90% of community pharmacists have provided NMS services to their patients, GPs aren’t always aware the service exists, says Gordon.
“There’s no standard referral system between GPs and pharmacists,” she explains. “I’ve spoken to many GPs who haven’t even heard of the service.”
She believes this model could easily be replicated in other parts of the country. “Other practices could get this set up for themselves in their area, if pharmacists and practices are willing to have those conversations.”
1 Royal Pharmaceutical Society (2013) Medicines Optimisation: Helping patients to make the most of medicines.
Find out more about Wessex AHSN at wessexahsn.org.uk or @WessexAHSN
For more on the prevention of strokes and other heart events, you can read our guides to the CVD Challenge in each of the UK nations.
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