In response to the following article:
Dear PIP Editor,
56 community pharmacies across three Scottish Health Boards from Tayside, Grampian, Greater Glasgow and Clyde, took part in the evaluation of a community pharmacy pathway.
The community pharmacies invited people attending their pharmacies and who were prescribed opioid substitution therapy to take a test for Hepatitis C, Hepatitis B and HIV.
The pharmacists diagnosed on-going Hepatitis C infection using a PCR test and reviewed of a panel of blood tests including liver function tests. They performed a liver fibrosis risk assessment test (FiB-4) from these test results and determined whether the patients could start treatment.
Prescriptions for the direct-acting antiviral medicines were either written by independent pharmacist prescribers or provided using a Patient Group Direction. The pharmacies then administered the treatment each day alongside the patient’s methadone or buprenorphine prescription.
Our evaluation of the views and perspectives of the staff taking part showed that they thought the opportunity to provide this care was a valuable addition to the range of services they offer. Pharmacists appreciated the opportunity to provide a wider range of clinical services and to help the patients attending their pharmacy practice to a greater extent.
The studies that evaluated this pathway showed that approximately twice as many people accepted the offer of a test from a pharmacy than from other services. And these patients were approximately twice as likely to achieve a cure for their hepatitis C infection than from other standard routes of care.
Our evaluation showed that the long-term trusting relationship with pharmacy staff, the local situation of the pharmacy within a community and the on-going reason to attend the pharmacy were key factors in this success. Patients did not need to find the money for bus fares or navigate their way around an unfamiliar hospital.
As a consultant in public health pharmacy, my role is to maximise the value that we achieve from the pharmacy and medicines resource.
Working with Professor Dillon’s Liver Group at Dundee University has created a range of opportunities for our work to showcase the health gain that can be achieved by investing in pharmacies and empowering pharmacists to deliver clinical services. My role was as Principal Investigator for the SuperDOT-C study that was led from NHS Tayside and to work closely with community pharmacy colleagues responsible for delivering this care.
NHS Tayside has a reputation for innovation and for pioneering new ways of caring for its population. The hepatitis C work has demonstrated that strong clinical leadership and multidisciplinary working, harnessing the contribution of the wider team, can provide world-beating outcomes.
Community pharmacies are present in each community and provide an accessible point of care for local people. We have shown that by utilising the community pharmacy resource, many of the barriers that prevent some of our most vulnerable groups accessing effective healthcare can be reduced.
Clinical effectiveness of pharmacist-led versus conventionally delivered antiviral treatment for hepatitis C virus in patients receiving opioid substitution therapy: a pragmatic, cluster-randomised trial.
Dr Andrew Radley
Consultant in Public Health Pharmacy