Parkinson’s disease-specific medicines use review

Members of Royal Pharmaceutical Society’s London North West Local Practice Forum (LNW LPF) are working with charity Parkinson’s UK to develop a new service for patients with Parkinson’s disease (PD). The overall aim is to develop a PD-specific medicines use review by designing and trialling it in an initial and follow-up trial.

The idea for the project arose from an LPF event (held in Harrow, Middlesex, in January 2014) in collaboration with the Centre for Pharmacy Postgraduate Education (CPPE). This was addressed by a PD specialist, a representative from Parkinson’s UK and a patient with PD who described problems he faced in everyday life. Interest was expressed among the audience in exploring how pharmacists could better support community-based PD patients.

At a subsequent stakeholder meeting at the UCB Pharma Ltd headquarters in Slough in March 2014, it was agreed that a MUR would be designed and piloted by community pharmacist members of the LNW LPF. The aims of the MUR would be to empower patients and increase their knowledge, achieve better integrated care, improve outcomes, potentially reduce costs to the NHS, identify and resolve problems where possible, and be an informative and fulfilling activity for participating pharmacists. With support from UCB Pharma Ltd, an advisory board was formed consisting a neurologist, specialist PD nurse, two clinical commissioning group lead pharmacists, a GP, a representative from Parkinson’s UK, LNWLPF lead, representatives from UCB and eight community pharmacists (who undertook relevant online training).

The initial meeting in November 2014 led to development of a toolkit containing a Parkinson’s UK information pack, details on how to order support materials for patients and also questionnaire and feedback forms. A patient questionnaire (developed by Parkinson’s UK and Salford Royal NHS Foundation Trust) was to be completed before the MUR to establish a baseline position.

Over two months (March to April 2015) the eight pharmacists conducted 32 PD-specific MURs across eight different pharmacies in North West London and collected data, including pharmacist and patient feedback. Analysis of the data was completed by UCB Pharma Ltd and discussed at a further advisory board meeting.

Patient feedback highlighted problems with non-motor symptoms, both behavioural and physical. Patients also lacked understanding of taking the right dose at the right time, whether medicines should be taken before or after food, frequency of doses, titration problems and how the medicines work. Patients welcomed the opportunity to provide feedback and were pleased to be able to talk to the pharmacist about their concerns and problems.

Around 96% of patients found the MUR useful, 86% felt their understanding of their medicines had improved and 92% thought other people with PD would benefit from this service.

Pharmacist feedback highlighted the need for good communication skills. The participants found the quality time with the patients “immensely satisfying” and they felt empowered having gained knowledge, competence and confidence.

In terms of outcomes from the MURs, four pharmacists identified cases of avoidable harm; six pharmacists reported improved compliance; five pharmacists saw an improvement in patient care; and two pharmacists reported better integrated care with improved communication with GPs.

The positive feedback has prompted a second trial phase with at least 150 MURs being undertaken by 50 pharmacists. Following a presentation at the Pharmacy Show (September 2016) additional pharmacists from outside North West London were recruited for the next phase. Findings from the pilots will be presented to the Pharmaceutical Services Negotiating Committee and NHS England, with a view to a national PD-specific MUR service being launched in 2018.

Stephanie Bancroft

London North West Local Practice Forum lead

Royal Pharmaceutical Society