Evidence-based clinical pharmacy services was the theme for this year’s European Society of Clinical Pharmacy (ESCP) symposium, which took place in Heidelberg, Germany, in October 2017, and there was plenty of thought-provoking and uplifting material in the programme.
Evidence driving practice
The most memorable presentation came from Ross Tsuyuki, a pharmacist and professor of medicine (cardiology) at the University of Alberta, Canada. He told delegates that pharmacy-managed hypertension achieves better outcomes and costs less than ‘usual care’ provided by physicians. In a series of controlled studies, community pharmacists demonstrated their effectiveness in managing hypertension, diabetes and dyslipidaemias — all according to the official Canadian guidelines. The separate threads were pulled together in the REACH study, which involved 56 community pharmacies and 723 patients. The researchers found a 21% relative risk reduction for cardiovascular risk (owing to improved adherence) and identified previously undiagnosed chronic kidney disease in 113 patients. Tsuyuki emphasised that all this work was done within the existing reimbursement framework for community pharmacists, so the scheme is sustainable and reproducible.
Pharmacists used a web-based cardiovascular risk calculator (available from EPICORE) to explain risks to patients and illustrate the effects of reducing weight or quitting smoking on an individual’s risk. The use of a ‘traffic light’ display is an effective way to communicate risk and leads to useful discussion, he said.
Separate economic analyses show that one million life-years and Can$15.7bn could be saved if community pharmacy prescribing for hypertension were implemented throughout Canada.
Identifying atrial fibrillation
Atrial fibrillation (AF) is a major risk factor for strokes and around 50% of AF is undiagnosed. Earlier this year, I heard that community pharmacists should be checking patients’ pulses, manually or electronically, to help diagnose AF. It was encouraging to hear that two studies involving community pharmacists in 10 countries have been doing this. Of 2,573 patients with a mean age of 65 years, an irregular pulse was detected in 8.3%, and AF has been confirmed in 1.4%.
I often receive emails inviting me to publish my research in journals I have never heard of, and a talk by Gerd Antes, head of Cochrane Germany, explained why. After describing the well-known problems that beset evidence-based medicine, such as failing to publish negative results and repeating studies with ever-larger numbers when the answer is already known, he described the phenomenon of predatory publishing further distorting the picture. He decried the publication of “redundant, misleading and conflicted systematic reviews” driven by perverse incentives for publication of systemic reviews and the publication of questionable research in open-access journals where the authors pay a fee for publication. These journals exist only to make money from authors — peer review is faked or ignored, and much of what is published is fringe or junk science. Predatory publishers choose names that are similar to the names of bona fide journals and commonly target academics to offer rapid publication.
News in brief
Many snippets of information stay with you after a conference, and these were mine:
- Non-adherence, untimely use of medicines, antibiotic overuse, medication errors, suboptimal use of generic medicines and mismanaged polypharmacy account for almost US$500bn of avoidable costs. Good-quality pharmacy research that gets the right answers hinges on the right patients, the right intervention and the right outcomes.
- Faecal microbiota transplant (FMT, a stool transplant) is an effective treatment for recurrent Clostridium difficile infection. In France, FMT is classed as a medicine that requires preparation under pharmaceutical supervision, and has been done at St Antoine Hospital, Paris, since October 2015.
- Melatonin is a safe and effective premedication for diagnostic procedures in children. A standardised preparation — most probably a hard capsule — is now required, according to French authors.
- A modified version of the STOPP/START (Screening Tool of Older Persons’ potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria is now in use in the UK Pharmacy Care Plan Service, a community pharmacy-based project designed to deliver person-centred care, according to developer Cristin Ryan, School of Pharmacy, Trinity College, Dublin. Nearly 700 patients have been recruited and completed the first phase.
- Mobile health (mHealth) will see the use of gadgets for medical tests instead of giving blood and being endoscoped. A miniature ‘camera in a capsule’ can now do the job, leaving just the awkward bit of recovering the capsule at the end of its journey.
The next ESCP workshop on ‘Expanding the roles and opportunities for the pharmacist in optimising use of oral cancer drugs’ will take place on 19–20 February 2018 in Reykjavik, Iceland. The deadline for registration is 22 January 2018. Find more information at: http://www.escpweb.org/Reykjavik