Jim Mc Ardle
Principal Clinical
Pharmacist
Who are Interface Clinical Services?
• Established in 2004
• Clinical Services Provider to NHS
• Operate UK wide using clinical pharmacists with
a wealth of experience
• Rigorous internal clinical governance procedures
overseen by Interface Clinical Director
• Directly commissioned to deliver services for
PCTs/PBC consortia/individual GP practices
• Deliver some pharmaceutical-industry sponsored
work
Salford PCT Calcium and Vitamin D3
Deficiency Protocol
• Sponsored by ProStrakan Pharmaceuticals
• Role of sponsoring organisation is limited to liaising between GP
practices and Interface Clinical Services to arrange date(s) of clinical
review
• Project has full support of Salford PCT Medicines Management Team
and Osteoporosis Clinical Management Team
• Project Aims
- To identify those patients who at risk of calcium and vitamin
D3 deficiency who may benefit from CaD3 supplementation
- Support therapy intervention and patient education
• Protocol reflects both national (NICE/SIGN) and local guidelines
(Salford PCT osteoporosis guidelines)
Salford PCT Calcium and Vitamin D3
Deficiency Protocol (continued)
Patient criteria for review
• Patients with osteoporosis (read code N330) untreated
• Patients receiving bisphosphonates without Ca and D3
supplementation
• Patients receiving oral corticosteroids (>7.5mg prednisolone or
equivalent for > than 3 months)
• Patients over 70 considered frail, increased risk of falls, or resident in
care/nursing homes
• Patients over 75 with a Hx of low trauma fracture since age of 50
• Patients on non-evidence based brands of Ca and D3
Salford PCT Calcium and Vitamin D3
Deficiency Protocol (continued)
Exclusion criteria
• Hx of hypercalcaemia
• Primary hyperparathyroidism
• Severe renal failure
• Pagets
• Sarcoidosis
• Hx of renal stones
• Hx of CaD3 intolerance
• Drug-drug interactions
• Osteoporosis due to prolonged immobilisation
Summary of findings (2008)
• 2454 interventions across all 48 practices
• Average 51 interventions per practice
• Interventions include:
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Identification of compliance issues
Initiation of medication (as authorised by GP)
Patient referral to GP
Identification of erroneous coding etc. to assist practice support teams
• Actual no. of interventions is dependent on:
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List size
Patient population breakdown
Work previously undertaken
Accuracy of read-coding
• 48 practices undertook the clinical review
• 39 completed in one day
• 8 required 2 days
• 1 required 3 days
Lesson learnt from 2008 Audit
• Successes
– Efficiency
– Positive engagement across all practices
• Compliance with calcium and vitamin D3 products
– 314 patients across 48 practices
– Re-audit programme?
• Quality of data captured
– Issues?
– Solution?
Plan for 2009
• PCT wide calcium and vitamin D3 clinical review programme
– Offered both to practices who undertook audit in 2008 and new practices
who did not uptake the review programme in 2008
Improve the quality of data reported
– E.g 2008 audit revealed number of fractures in patients over 75. In 2009
we will look at prevalence data which will allow for practice
benchmarking year on year
• Build on existing protocol through new inclusion criteria including:
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Patients receiving aromatase inhibitors for treatment of breast cancer
Patients 50-74 with a history off a low trauma fracture
Patients identified as non-compliant on bisphosphonates
New Osteoporosis DES
Important Information
– To obtain the service please contact:
• Jennifer Richardson
(ProStrakan Representative- 07989991517)
– Queries around protocol criteria etc:
• Contact Gaynor Loghan
– Specific queries regarding service delivery can answered by:
• Jim McArdle
(jmcardle@interface-cs.co.uk/ Mobile 07894415170)
• More information about Interface Clinical Services please visit
www.interface-cs.co.uk