Community pharmacies can help identify undiagnosed cases of chronic obstructive pulmonary disease (COPD) at an early stage, which could result in savings of around £264m per year, a pilot study suggests.
More than half of people screened by pharmacies in a pilot were identified as being at higher risk of COPD, the results of the Community Pharmacy Future project’s COPD case finding service show.
The researchers who analysed the pilot’s findings in the International Journal of Pharmacy Practice
suggest that scaling the service up across 11,100 pharmacies in England might identify 205,175 smokers who are at risk of COPD, and yield £264m of NHS and societal savings (noted as per patient benefit in the original paper).
This is the first time the screening model has been tested in community pharmacies in the UK. The pilot took place in 21 pharmacies in the Wirral, England, between September 2012 and April 2013.
Smokers and patients who regularly purchased cough medicines were invited to participate in the pilot. Those who agreed were given a disease risk-assessment questionnaire to gather information about their age, smoking habits and any respiratory symptoms. Micro-spirometry was also used to measure their forced expiratory volume in one second (FEV1).
Of 238 patients screened, 135 (56.7%) were found to be at risk of having undiagnosed COPD and were given lifestyle advice and referred to a GP. Their at-risk status was based on having a high score on the risk-assessment questionnaire, an FEV1 of less than 80% of the predicted normal value or an FEV1 to FEV6 (in six seconds) ratio of less than 0.7.
Nearly two thirds (88 or 65.2%) of those deemed at risk were current smokers and were offered smoking cessation support, which was accepted by at least 46 patients.
The savings estimate relies on the proportion of at-risk individuals identified by the screening holding nationally. Furthermore, the costs data come from theoretical models of the cost-effectiveness of smoking cessation in COPD patients, and are based on assumptions that might not accurately reflect reality, the researchers warn.
“A simple cost analysis based on the smoking cessation element alone suggests that, providing the cost per patient screened is less than £400, then the service should be adopted by the NHS — i.e. the costs are less than the current model of doing nothing,” says David Wright, lead author of the paper and professor of pharmacy practice at the University of East Anglia school of pharmacy.
Toby Capstick, lead respiratory pharmacist at Leeds Teaching Hospitals NHS Trust and joint chairman of the United Kingdom Clinical Pharmacy Association Respiratory Group, says the study demonstrates that pharmacists are well placed in the community to help identify people who may be at risk of COPD but noted that the effects of providing the service are “not known”.
“It would be interesting to determine whether pharmacists identified at-risk people who subsequently had a confirmed COPD diagnosis from their GP [and received] treatment, or whether they successfully stopped smoking,” he says.
“This would allow a more accurate assessment of the value to the NHS of a community pharmacy COPD case-finding service.”
The pilot evaluation was jointly funded by multiple pharmacies Boots, the Co-operative Pharmacy, Lloydspharmacy and Rowlands Pharmacy as part of the Community Pharmacy Future project, which was launched in 2011 to help develop the community pharmacy funding model.
- This article was amended on 12 November 2014 to clarify that the researchers’ calculation of £264m in potential savings was not explicitly included in the original article published in the International Journal of Pharmacy Practice but was provided to The Pharmaceutical Journal in a press release
and is available on the Community Pharmacy Future project website.
 Wright D, Twigg M & Thornley T. Chronic obstructive pulmonary disease case finding by community pharmacists: a potential cost-effective public health intervention. International Journal of Pharmacy Practice 2014. doi: 10.1111/ijpp.12161.