plus
Home > Case Study > Optimisation of inhaled corticosteroids in COPD patients in West Cheshire

Optimisation of inhaled corticosteroids in COPD patients in West Cheshire

 

This project to optimise the use of inhaled corticosteroids in patients with chronic obstructive pulmonary disease (COPD) quickly delivered improvements in patient care as well as cost efficiencies.

Background

RightCare data for West Cheshire Clinical Commissioning Group (CCG) show high incidences of flu and pneumonia and high levels of prescribing spend on inhaled corticosteroids (routinely within the top 10 cost drugs for each practice). Furthermore, West Cheshire CCG prescribing costs for tiotropium are the highest in England. This project set out to improve patient care by optimising the prescribing of inhaled corticosteroids in COPD patients.

Action

Using the knowledge and communication skills of pharmacists in a face-to-face setting with patients, we aimed to improve patient health, concordance and inhaler technique, whilst reducing safety risks and prescribing costs associated with these drugs.

Pharmacists worked one day per week in five practices for three months liaising closely with practice respiratory nurses and the lead respiratory GP. GOLD criteria and local COPD guidelines were used to identify patients potentially suitable for step-down and/or stop of inhaled corticosteroids. These patients were invited to attend the practice for a consultation with a respiratory nurse or pharmacist, bringing all inhalers, including excess, with them. Where appropriate, step-down of inhaled corticosteroid dose was recommended and patients were followed up to ensure they were managing the new regime without experiencing any problems. Changes to cost-effective dry powder inhalers or metered dose inhalers with a spacer device were instigated where appropriate.

Patients not suitable for step-down were reviewed by a pharmacist and inhaler technique was checked and demonstrated. Domiciliary visits were carried out for patients not able to attend the practice.

Impact

By the time the project reached 84 per cent completion we had made:

  • 57 quality interventions to improve patient care, experience and outcomes
  • cost efficiencies of £28,682.67 (surpassing our end target of £26,000).

An added benefit was that the role of pharmacist was developed and promoted within GP practices. Due to the success of this pilot project we plan to roll this work out across all GP practices in West Cheshire and across our wider Medicines Management and Optimisation teams. Future work will focus more specifically on the step-down and/or stopping of inhaled corticosteroids in suitable patients.  Given the clinical benefits to patients and cost improvements demonstrated, we are encouraging our practice pharmacists to work closely with practice nurses and GPs to improve medicines optimisation in patients with COPD.

Contact information

Diane Hornsby, Medicines Optimisation Pharmacist

Mobile: 07787004285   Email: diane.hornsby@nhs.net

Get in touch

Kingston House

438-450 High Street
West Bromwich
West Midlands
B70 9LD

0300 404 2999
  • Heron House
  • Springfields Health & Wellbeing Centre

Midlands and Lancashire CSU
120 Grove Road
Stoke on Trent
ST4 4LX

0300 404 2999

Midlands and Lancashire CSU
1st Floor
Lovett Court
Rugeley
WS15 2QD

0300 404 2999
Jubilee House

Midlands and Lancashire CSU
Lancashire Business Park
Leyland
Lancashire
PR26 6TR

01772 214200
Liverpool Innovation Park

Office 2
2nd Floor
Building 2
Liverpool Innovation Park
360 Edge Lane
L7 9NJ

0151 295 8612/8619
  • 1829 Building, Chester
  • Old Market House
  • Clark House

1829 Building
Countess of Chester Health Park
Liverpool Road

01244 650 351

Hamilton Street
Birkenhead
Merseyside
CH41 5AL

0151 514 2335 EXT 1487

Hulley Road
Macclesfiled
Cheshire
SK10 2LU

01606 544 791
Cardinal Square

3rd Floor North Point,
10 Nottingham Road,
Derby DE1 3QT
East Midlands

01332 868700
St Johns House

St Johns House
30 East Street
Leicester
Leicestershire
LE1 6NB
United Kingdom

0121 611 0100
map