The role of pharmacists in preventing cardiovascular disease

By Dr Duncan Petty, Member of the English Pharmacy Board

It was great to see the news this week about how the NHS plans to make greater use of community pharmacy to help prevent 150,000 strokes, heart attacks and cases of vascular dementia, supporting earlier detection and management of cardiovascular risks.

Cardiovascular disease incidence can be reduced through better lifestyles and the optimisation of preventative medicines, such as antihypertensives and statins to prevent vascular strokes and ischaemic heart disease / myocardial infarction, and anticoagulants for stroke prevention in atrial fibrillation.

NHS plans will include using pharmacists in the community (community pharmacy and general practice-based) to work on identification of at-risk individuals; offering lifestyle advise and supporting long-term changes in poor lifestyle; offering or optimising preventative medicines, and helping patients remain on these medicines. Pharmacists having been doing this work around the UK for many years. The difference going forward is that these services will be done in a systematic way and on a wider scale.

The community pharmacy contract could see (subject to successful pilots and roll-out) screening services for hypertension and atrial fibrillation. In general practice pharmacists might already be familiar with using tools such as AlivecorR to detect AF and most pharmacist will be able to measure blood pressures. However, to advise patients on 10-year cardiovascular risks a cholesterol level will be needed as will skills in using risk calculators such as QRISK 3.

For patients with a high cardiovascular risk score, overall risk can be reduced through lifestyle (especially smoking cessation support); reduced blood pressure (from lifestyle changes and introduction on antihypertensives) and offering statins at an evidence-based dose. There are plenty of examples where pharmacist have been involved in case finding untreated and undertreated patients and offering medicines optimisation and lifestyle support, which you can read about in our roundtable report.

Offering oral anticoagulants (OACs) for stroke prevention in AF (SPAF) is more complex and requires skills and knowledge on what are true contraindications to OAC (actually there are very few); access to the full medical history and team work with the GP and specialist pharmacy anticoagulant services. Most patients when they have had risks and benefits of OAC explained to them are keen to accept therapy but pharmacists need to be skilled in running these types of consultations.

Once patients are prescribed OAC, statins and antihypertensives ongoing reviews are required. Community pharmacy will be well placed to support adherence and to offer patients ongoing advise on reducing bleed risks from OACs (e.g. using the HAS BLED tool) but to perform a full clinical review of most CV medicines access to the clinical record will be required e.g. to check monitoring parameters such as U+Es, full blood count etc). There is nothing to stop community pharmacists performing these reviews if they are given access to the patient’s clinical record. Whether community pharmacy access is granted or not is dependent on local arrangements and funding, but examples exist across whole communities such as in Fleetwood.

Cardiovascular medicines optimisation services are already running in parts of the NHS. What we need now is to share the learning and adopt standardised services at scale to help improve patient care, safety and value to the NHS.

Read our roundtable report on pharmacy and cardiovascular disease.

Diabetes care – get involved!

by Professor Mahendra G. Patel, Diabetes Lead, English Pharmacy Board

Today we’ve published our new policy ‘Using pharmacists to help improve care for people with Type 2 Diabetes’. Aimed at policy makers and service commissioners within the NHS in England, it calls for pharmacists in various care settings to be fully integrated into services for those with Type 2 diabetes. This makes way for increased prevention, earlier detection, and better access to diabetes care tailored to individual needs.  

More than five million people in the UK are expected to have Type 2 diabetes by 2025. This is a national challenge in terms of poor health outcomes, economic burden to the NHS, and ever-widening health inequalities largely driven by factors such as ethnicity and deprivation. Each year within hospitals, there are thousands of patients with diabetes experiencing medication errors that could be avoided.

Significant numbers of people are failing to meet the nationally recommended treatment targets in reducing risk of complications associated with type 2 diabetes. Many are not understanding their condition nor adhering to prescribed treatment. In my opinion, this is a critical time to make more effective use of the extensive clinical skills of the pharmacist.

The NHS Long Term Plan recognises the vital role of pharmacists and their clinical skills in supporting patients to achieve better health outcomes, improving patient safety and reducing medication errors. The recent establishment of new Primary Care Networks and the growing maturity of local Integrated Care Systems, together provide unparalleled opportunities for people to receive better access to their pharmacists, more personalised support, and joined-up care at the right time in the optimal care setting.

In line with new and emerging roles for pharmacists and advancing practice, and at a time when technology is set to command a pivotal role in healthcare, our new policy on diabetes builds on our previous national campaigns.

It translates the latest evidence into practice, focusing on helping people to live longer and lead healthier lives whilst ensuring effective and safe use of medicines. It further highlights the need to support services within and across different care settings, where pharmacists can make significant and meaningful differences in improving health outcomes.

It also shows how pharmacists, who are integrated within a specialist diabetes multidisciplinary team, can provide added value and synergy across care pathways as routine daily practice.

Professor Sir David Haslam, Chair of NICE, one of the many organisations supporting our policy states, ‘Diabetes is a public health emergency’. We will continue to press these recommendations to progress this crucial national work.

Your mental health: wellbeing advice from Pharmacist Support

Helen Tester, Wellbeing Co-ordinator from Pharmacist Supportby Helen Tester, Wellbeing coordinator at Pharmacist Support – the independent charity for pharmacists, trainees and MPharm students.

11-17th May marks Mental Health Awareness Week – a time to reflect on and help raise awareness of mental health and wellbeing issues. According to an ONS study one in four of us will suffer from a mental health illness at some point in our lives. If this is the case how can we stay mentally healthy? Read more Your mental health: wellbeing advice from Pharmacist Support

How your pharmacist can help prevent falls

annamarieBy Annamarie McGregor, Professional Support Pharmacist for the RPS in Scotland

This week is Age UK’s Falls Awareness Week (17th-21st June). Every year around 30 per cent of over 65s will fall; this increases to 50 per cent in those aged over 80. Falls can be a particular worry for older people and can cause a loss of mobility and confidence; for some the consequences can even be fatal. A lot can be done to prevent falls and this awareness week should also act as a reminder to the public that pharmacists can help reduce the risk of falls among older people. Read more How your pharmacist can help prevent falls

Cervical cancer prevention week

By Robert Music, director of Jo’s Cervical Cancer Trust

I am director of Jo’s Cervical Cancer Trust, the UK’s only charity dedicated to women, their families and friends affected by cervical abnormalities and cervical cancer. We offer a range of support and information both online and face to face.

Cervical cancer is the second most common cancer amongst women aged 35 and under in the UK and every day 3 women a day in the UK die from cervical cancer and each year around 2,800 are newly diagnosed.  In addition some 300,000 women a year are told they may have a cervical abnormality that might require treatment. Read more Cervical cancer prevention week