Community pharmacy COPD services: what do researchers and policy makers need to know?

Integrated Pharmacy Research and Practice Dovepress open access to scientific and medical research REVIEW Integrated Pharmacy Research and Practice downloaded from https://www.dovepress.com/ by 88.198.20.149 on 08-Oct-2019 For personal use only. Open Access Full Text Article Community pharmacy COPD services: what do researchers and policy makers need to know? This article was published in the following Dove Press journal: Integrated Pharmacy Research and Practice 7 February 2017 Number of times this article has been viewed Michael J Twigg David J Wright School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich, UK Abstract: COPD is a leading cause of morbidity and mortality across the world and is responsible for a disproportionate use of health care resources. It is a progressive condition that is largely caused by smoking. Identification of early stage COPD provides an opportunity for interventions, such as smoking cessation, which prevent its progression. Once diagnosed, ongoing support services potentially provide an opportunity to assist the patient in managing their condition and working more closely with the rest of the primary care team. While there are a number of robust studies which have demonstrated the role which pharmacists could undertake to identify and prevent disease progression, adoption of such services is currently limited. As a service that would seem to be appropriate for adoption in all societies where smoking is prevalent, we have performed a review of reported approaches that have been used when setting up and evaluating such services, and therefore aim to inform researchers and policy makers in other countries on how best to proceed. Implementation science has been used to further contextualize the findings of the review in terms of components that are likely to enhance the likelihood of implementation. With reference to screening services, we have made clear recommendations as to the identification of patients, structure and smoking cessation elements of the program. Further work needs to be undertaken by policy makers to determine the approaches that can be used to motivate pharmacists to provide this service. In terms of ongoing support services, there is some evidence to suggest that these would be effective and cost-effective to the health service in which they are implemented. However, the capability, opportunity and motivation of pharmacists to provide these, more complex, services need to be the focus for researchers before implementation by policy makers. Keywords: COPD, community pharmacy, screening, spirometry, smoking cessation Introduction Correspondence: Michael J Twigg School of Pharmacy, Norwich Research Park, Earlham Road, Norwich NR4 7TJ, UK Tel +44 1603 592015 Email 53 submit your manuscript | www.dovepress.com Integrated Pharmacy Research and Practice 2017:6 53–59 Dovepress © 2017 Twigg and Wright. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IPRP.S105279 Powered by TCPDF (www.tcpdf.org) In 2012, COPD was the fourth largest cause of mortality in the world,1 resulting in 3.1 million deaths. This figure is due to rise as a result of the increasing age in the population and prevalence of smoking particularly in low- and middle-income countries.2 There is a significant inter-country variation in the prevalence of COPD with estimation ranging from 5% to 20%3,4 with an overall average of 7.6%.2 There is also a stark variation in the outcomes associated with COPD particularly death rates (4.4/100,000 in Japan versus 130.5/100,000 in People’s Republic of China) and disability-adjusted life years (120 in Japan versus 667 in India).5 Usually occurring during midlife, COPD is characterized by reduced lung function, that is slowly progressive and not fully reversible.6 The element of reversibility is the main feature that distinguishes COPD from asthma.5,7 Both the World Health Integrated Pharmacy Research and Practice downloaded from https://www.dovepress.com/ by 88.198.20.149 on 08-Oct-2019 For personal use only. Twigg and Wright rganization and the Global Initiative for Chronic ObstrucO tive Lung Disease (GOLD) state that COPD is both preventable and treatable.1,6 Major causes of the condition include tobacco smoke, occupation dust, vapors and fumes and outside air pollutants.6 Risk factors include genetic predisposition, increasing age and infection. Repeated insult from foreign and toxic bodies causes long-term irreversible damage to the structure of the lungs, which becomes progressively worse as exposure continues. Therefore, the main treatment for COPD is the removal of the cause. If left untreated, COPD symptoms will gradually worsen leading to further complications and eventually death. It has been hypothesized that systemic complications can also arise from COPD as a result of an “overspill” of inflammatory mediators from the lungs into the systemic circulation.8 This can give rise to additional comorbidities, such as cardiovascular disease, diabetes and chronic infections.9–11 Other comorbidities associated with COPD include depression12 and muscle wasting.9 As a result of both COPD and its complications, the economic burden of the disease to health care systems and society is significant. It is difficult to assess the cost of COPD, however, as the disease worsens these costs increase dramatically.5,13,14 This increase in costs incurred can be traced to the increased risk of infection due to reduced ability to deal with external pathogens, causing an increased demand for antibiotics and reduced lung function, which results in increased contact and cost to the health service. Another key aspect of COPD is patients’ ability to manage their own condition and take their medicines as prescribed. If patients are not able to do this, then this will also result in further contact with health services as their condition deteriorates. All of these results in a greater number of general practitioner (GP) appointments, greater number of prescribed medicines, increased hospitalizations and decreased quality of life and productivity. Until recently, pharmacists’ main role in patients with COPD centered on prescription supply and counseling on medicines, including inhaler technique. However, with the recent development of more patient facing, clinical and public health roles for pharmacists’ new a (...truncated)