Developing an enhanced pharmacy-led adherence checking service within a severe asthma centre

Context

Severe asthma causes significant symptom burden and impact on patients’ quality of life, and traditional treatment with oral corticosteroids (OCS) is associated with damaging side effects. Six biologic therapies are now licensed for adults with severe asthma in England however, their uptake has been slow. They were therefore selected by the NHS England Accelerated Access Collaborative Rapid Uptake Products programme in September 2020, aiming to improve access. Checking adherence to prior treatments, including inhaled corticosteroids (ICS) and OCS usage, is essential when identifying and assessing patients for biologics.

Problem

The pre-existing service only completed adherence checks on patients already being considered for biologic therapy. Patients were worked up for months before realising they were not adherent or eligible, contributing to wasted time and resources, limited/delayed biologic uptake and poor patient experience.

Intervention and strategy for change

Within an acute NHS hospital trust, a pharmacy-led service was developed over two years. All new patients referred to the severe asthma clinic have a comprehensive adherence check completed by a specialist respiratory pharmacist or medicines management technician (MMT) prior to their first appointment. A SOP and proforma to record adherence information was developed. The completed proforma is uploaded to the patient’s hospital record.

Measurement of improvement

• 427 patients were referred to the clinic from October 2021 to October 2023, with 371 (87%) adherence checks completed (55 unable to gain consent and 1 GP didn’t provide information)
• 72 patients’ ICS adherence was below the standard of 75% Medicines Possession Ratio (MPR)
• The pharmacist considered 51 patients suitable for biologics based on adherence, optimised medication and OCS courses. 22 (43%) are now on biologic (above pre-project national average of 18% deemed as suitable but not receiving biologic)
  • A mean of three months from first consultant clinic to multidisciplinary team meeting (MDT) (pre-project work-up varied from 1 month to years)
  • A mean of two months from MDT to starting biologic (pre-project 25% >6 months as adherence issues required repeat MDTs)
• Asthma MDT continually gives positive feedback.

Effects of changes

Non-adherent patients were supported to improve adherence before biologic consideration. Adherent patients were assessed and initiated on a biologic sooner, thereby removing inefficiencies and increasing the uptake of biologics. Challenges encountered included time limitations and inability to contact patients for consent or to review poor adherence in pharmacist-led clinic.

Conclusions

The introduction of a pharmacy-led adherence checking service has had a clear positive impact which supported the additional funding of a 0.5WTE band 8a pharmacist. Furthermore, a MMT was recruited, allowing the pharmacist to develop additional pathways.

Long term goals include:

• setting up an in person pharmacy-led adherence clinic;
• reviewing the current proforma to assess other relevant co-morbidities such as rhino-sinusitis; and,
• developing a new pharmacist/asthma nurse triage process to further streamline referrals.

Additional authors: N. Hudson, R. Edwards, Nottingham University Hospitals NHS Trust

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement:

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.