Pharmacists can play a key role in supporting patients with long-term lung conditions, but what should they consider before setting up an inhaler technique service?
Key learning points
- Do your research first to ensure there is a market need for the service
- Make sure pharmacy staff delivering the service receive appropriate training
- Use marketing tools effectively to communicate how the service works
Why inhaler technique services are important
Inhaler technique services provide support for patients with long-term respiratory conditions, such as chronic obstructive pulmonary disease (COPD) and asthma.
Asthma is the most common lung disease in the UK, affecting 5.4 million people, but recent reports have warned that basic care for patients is still not up to scratch.
In 2015, a review of asthma deaths, published by the Royal College of Physicians, found that nearly a quarter of asthma patients who died were receiving less than satisfactory care. Over half (58%) of patients were also being treated for mild or moderate asthma at the time of death, which suggested the condition was poorly-controlled or under-treated, rather than truly mild or moderate, the report said.
Similarly, COPD affects an estimated three million people in England, but only 900,000 have received a ‘clear and accurate’ diagnosis and are receiving appropriate treatment, according to an outcomes strategy published by the Department of Health in 2011.
Both reports indicated that improving inhaler technique could contribute significantly to improving the symptoms and outcomes of patients living with these conditions.
How pharmacists can help
Dr Andy Whittamore, clinical lead at the national charity Asthma UK, says pharmacists can play a vital role in reinforcing asthma education, ‘particularly around the links between symptoms and the increased risk of an asthma attack’.
He adds that pharmacies are in a unique position because most people see their pharmacist more frequently than their GP and they therefore have the opportunity to quickly assess a person’s adherence to their medication. They may notice, for example, that a patient is collecting multiple prescriptions for reliever inhalers, which would be a warning sign that their asthma is not under control, he says.
‘Inhaler technique can easily be assessed in a community pharmacy setting and if pharmacists are able to check asthma control and medication use, it will help to highlight those patients who need more support with their condition,’ he says.
Research your market
The structure of an inhaler technique service varies across the sector, but it commonly consists of an initial consultation and follow-up appointment.
A pharmacist will assess the person’s inhaler technique and, where necessary, retrain them to use their device more effectively or refer back to a GP or practice nurse if they identify that the patient needs a different type of inhaler.
Gavin Birchall, a pharmacist and marketing expert, says the first step for any pharmacist wanting to set up this type of service is to do their research and check whether there is a market and need for the service locally.
Research can ‘simply be asking patients how they access advice about their inhalers,’ Mr Birchall says, but it’s important to understand what need people have, how it’s currently being met and whether they are satisfied with this provision.
‘You might find, for example, that there is a clinic at the local GP surgery for inhaler technique but it’s oversubscribed, so that would be an opportunity,’ he adds.
Undertake appropriate training
The next step is to secure appropriate training for pharmacy staff, says Nick Hunter, chief officer for Doncaster’s Local Pharmaceutical Committee (LPC).
Mr Hunter was responsible for putting the business case and service specification together for delivering an inhaler technique service in Doncaster pharmacies, which was first commissioned in 2013 to ‘take some pressure’ off acute and primary care. The service is now available in approximately 60 pharmacies in the locality.
He says staff delivering the service must have the ‘right training’ and recommends a programme delivered by Jon Bell, director of Canday Medical Ltd, or the version delivered by the Centre for Pharmacy Postgraduate Education (CPPE).
‘There are so many different inhalers with different inspiration rates, so it’s important to understand how they work because otherwise you can make things more difficult for the patient, rather than better,’ he says.
Consider the costs
Pharmacists will also need to consider what equipment they need to assess someone’s asthma, which could include placebo inhaler devices, peak flow meters and In-check, a device that measures how quickly a patient is breathing in.
Mr Hunter says placebo devices are important because you need to be able to show how the different inhalers work, particularly if a patient is struggling with the device they have. These are generally free and provided by manufacturers, he adds, and aside from buying In-check (£20), it’s ‘not a hugely expensive’ service.
In Doncaster, the inhaler technique service is commissioned by the clinical commissioning group (CCG) and is provided free of charge to patients, with pharmacists receiving a unit service fee of £10 for each check they carry out.
Mr Hunter says he doesn’t see why others couldn’t charge for the service - ‘especially for the right demographic of people who are prepared to pay for getting good advice’ - but he says it’s up to pharmacists to make a judgment of value.
Rohit Jamnadass, the contractor at Pearcare Pharmacy in Surrey, received no funding to set up the inhaler technique service in his pharmacy, which has been running for four years. He delivers it to patients free of charge, but advises pharmacists to consider the initial start-up costs before they proceed.
‘Obviously cost is a big issue at the moment and as well as the initial set-up cost, you’ve got a small ongoing cost of disposable mouth pieces,’ he says.
‘It’s always a balance of working out if you want to charge or not – I’m someone who’s very “softly, softly” so I try not to charge if possible, but others may wish to and be successful in doing so.’
Promote and communicate
The final step pharmacists should consider is how to market the service. Mr Birchall says it’s important to communicate that ‘you have built a service that works’.
There’s a variety of tools pharmacists can use, he adds, including posters, putting leaflets in with prescriptions for inhalers or getting drivers to drop them off at patients’ houses, an advert on their pharmacy’s website and even social media.
‘It is not just about traditional marketing, it is more about understanding what your patient needs, making sure that people know what you have built for them and include in those communications why you’ve done it and why it works,’ he says.
Mr Jamnadass agrees that raising awareness of the service is one of the most important aspects – and it’s something he’s struggled with in his area, despite displaying posters and leaflets in the pharmacy and contacting practice nurses.
‘Community pharmacy can sometimes get hectic so if the patient knows they can come in and have a chat with us, that helps, rather than us having to do an “opportune catch” as such of a patient who is need of the service,’ he says.
Although he’s not seen a massive uptake of the service, Mr Jamnadass says it has still been very worthwhile, adding, ‘if you improve one person’s life, it’s definitely worth it because that’s what it’s all about isn't it - it’s not all about the money.'