We read with interest the article by Cook and Buchanan in the November issue of The Pharmaceutical Journal
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It is apparent that there is a very different state of play in Scotland compared with the situation in England and Wales, as explained by these authors, who note that further challenges are likely to be encountered before community pharmacy can become a ‘one-stop shop’.
The Scottish Government has set out its policy objective to eliminate hepatitis C as a public health concern, and community pharmacy in Scotland is already making a substantial contribution to this. ‘Achieving excellence in pharmaceutical care: a strategy for Scotland’, published in August 2017, describes a distinctive approach to integrated working, where the use of community pharmacists to provide pharmaceutical care is improved and increased. The strategy aims to develop workforce capability through vocational training and enhanced clinical leadership, with substantial investment in the training of pharmacist prescribers in primary care.
The hepatitis C virus (HCV) is predominantly associated with injecting drug use, and pharmacists and their teams have more direct contact with the people they treat for substance misuse than any other health or social care staff. Every community pharmacy in Scotland is now set up to support their patients through HCV therapy and supply the regimen in a patient-specific manner including supervised supply. This standard of care partnership between the patient, community pharmacist and the specialist hospital team has been a great success for all those involved, ensuring seamless delivery of care and achievement of the best clinical outcomes. This integrated care has allowed even chaotic patients to be cured of HCV with all the individual and public health benefits that a cure brings.
The Scottish Viral Hepatitis Pharmacy Specialist Interest Group is a very active team, which meets at regular intervals throughout the year to share best practice and discuss the problems or obstacles we face in our day-to-day care of this patient group. Through this group we are able to review national and international conference publications including research from our own members[1]
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Cook and Buchanan note the publication of a feasibility cluster randomised trial in Dundee, which provides evidence that community pharmacists can test people for hepatitis C, diagnose hepatitis C infection, assess for treatment, prescribe treatment, deliver treatment and successfully make a significant contribution to achievement of health policy. SuperDOT-C, a definitive cluster randomised trial that utilises this community pharmacy care pathway, is currently recruiting across five sites from health boards in Scotland. The study should report at the end of 2018. We look forward to reviewing the outcomes from this work, which is designed to compare this pharmacist-led intervention with the current standard of care.
Tom McEwan
Specialist clinical pharmacist, gastroenterology, liver and nutrition, NHS Tayside, Scotland
Katherine Davidson
Advanced clinical pharmacist, hepatitis C, NHS Lothian, Scotland
On behalf of the Scottish Viral Hepatitis Pharmacy Specialist Interest Group
References
[1] Marra F, Datta S, Priest M et al. Introduction of directly observed community pharmacy dispensing of directing acting antivirals achieves high sustained viral response rates in a difficult to treat cohort. J Hepatol 2016;64(2):S766. doi: 10.1016/S0168-8278(16)01493-8
[2] Boyle A, Marra F, Fox R et al. Partial directly observed therapy with ombitasvir/paritaprevir based regimens allows for successful treatment of patients on daily supervised methadone. J Hepatol 2017;66(1):S282. doi: 10.1016/S0168-8278(17)30881-4
