Medicines Optimisation in the Diabetes Care Pathway
Swindon and Wiltshire LPC Open Meeting 19th July
At diagnosis & through early treatment
(Where does diabetes start? – prevention/screening)
Who is the patient in contact with?
How often?
What support and advice is available/wanted?
Opportunities for medicines optimization
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GP (only see GP a lot if type I, or II with
complications)
 Pharmacy
 Diabetes UK groups/other voluntary sector
 Mentors
 Dieticians
 Podiatrists
 Family & friends
 Diabetic nurse
 Optician
 Smoking cessation
 Weight loss
 DAAT
 Hospital Consultant
Depends on patient need
 Practical advice
 Family
 Healthy eating, dietary
 ‘ownership’ of disease, taking responsibility
(more compliance)
 Pharmacy could be first port of call
 Don’t often accept seriousness of condition
 Difficult to get access to GP – feel let down?
 Differences in advice between GP and
Pharmacist??
 Someone to ask questions, problems on
periphery. Understanding what and why
taking medicines
 Personal contact
 Diabetes UK leaflets (would like tp access via
pharmacy)
 Pharmacist distant figure, wouldn’t think to
ask questions
 Stepped approach – access more as need it
 Difficult to optimize early
 At first prescription
 Contact with GP/diabetes nurses
 NMS, MUR? Awareness of pharmacy services
 Prevention & screening
 Monitoring
 NICE guidelines – increasing dosage gradually
(not always monitored effectively by GP)
 BP tests
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Through stable treatment
Who is the patient in contact with?
How often?
What support and advice is available/wanted?
Opportunities for medicines optimization
Deterioration or improvement in condition
Who is the patient in contact with?
How often?
What support and advice is available/wanted?
Opportunities for medicines optimization
Diet
NICE targets
GP/Nurse influence pathway
As above; type I and II have different needs
 Review annual or 6 monthly?
 One stable patient example:
o Podiatrist every month
o Pharmacist every 28 days
o GP 2 x week
o Opticians 2 x year
o Dietician monthly
o Hospital 2 x month
o Diabetic nurse ad hoc
Pharmacist – monitoring medicines, interaction,
compliance, health & wellbeing advice
 Synchronisation
 Co-morbidities
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GP – referral?
Pharmacist
Diabetes nurse
Friend/family accompanying (in case of patient
forgetfulness, to aid family understanding of
disease)
 Patient referral process – needs to be designed
around clinical issue as well as patient convenience
 Eye specialist
Probable Increase in contact
 Diet support
 Smoking cessation
 Synchronisation
 Co-morbidities
Healthcare contact for other conditions
Who is the patient in contact with?
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How often?
What support and advice is available/wanted?
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Different specialists Obesity
CV issues
BP raised
AF
Feet
Eyes
COPD/Asthma
Diabetes affects everything – overarching problem
Variable
Simple information
One co-ordinator in charge of care
Information available when it’s needed
Avoid duplication
Engage the diabetic specialist team in secondary
care
Opportunities for medicines optimization
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Confidence in non-GPs
NMS
Simple information at the right time, in accordance
with what patient needs
Synchronisation
Really deliver repeats properly
MUR
Recognise hypoglycaemia
Initiate insulin in pharmacy (Warwick course)
Public perception
Health & wellbeing interventions
CP particularly
Managing repeats
Insulin initiation in pharmacy (Independent
Prescribers)
Public confidence in these services
Taking it forward – ideas:
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‘What does pharmacy do?’ leaflet available in every pharmacy
LPC outreach activity to promote community pharmacy to stakeholders– schools, colleges,
library, shopping centres etc
Promote diabetic MURs and run for a period of time, link to seminar event in November
Pharmacist speak to local GP, LPC to provide material and work with LMC
GP provide list of patients and ask for feedback post-MUR/discussion
Raise profile of pharmacy in the community
Communication/promotion/marketing our services - MUR etc
Pharmacist advice – publicise via Age UK, Diabetes UK etc
Day care centres – Pharmacy Health Care Assistant attending to give advice to older people
Improve professional relationships and awareness cross working – link in to Electronic
Prescription Service?
Warwick training, insulin initiation by independent prescribers (all hands to the pump)
Involve family
Present:
Community Pharmacy
(all LPC members/officers)
Fiona Castle – LPC Chief
Paul Eyles – Boots, Area
Officer
Manager
Arvinder Sagar – Morrissons
Jane Goodhew – Boots,
Pharmacy, Chippenham
Marlborough
Jon Phillips – Lloyds
Kantha Moodley – Boots,
Pharmacy, Chippenham
Pharmacist
Nick Jephson – Jephson
Chris Shields – Boots,
Pharmacy, Wroughton &
Corsham
Marlborough
Robert Townsend –
Paul Hedge – The Pharmacy,
Ashington Way Pharmacy,
Tidworth
Swindon
Kaushik Patel – Hawthorne
Charlie Wu – Lloyds
Pharmacy, Swindon
Pharmacy, Moredon
Steve Green – Rowlands
Sarah Billington –
Pharmacy, Area Manager
Hampshire LPC
Secondary Care
Denise Reeves – Lead
Pharmacist, Clinical
Services, GWH
Others
Toni Lloyd – Medicines
Governance Pharmacist,
NHS Swindon
Mary Wilson – LINk
representative, Wiltshire
Norman Holland – Patient
representative/
Diabetes UK ‘Diabetes
Service Champion’ for
Wiltshire & BaNES
Les Sharpe – Patient
representative, Diabetes
UK
Dr Gareth Bryant –
Wessex LMC
Lis Jardine – Engagement
Officer, S&W LPC
Chris Phillips – Contracts
Manager, NHS Wiltshire