NHS England is asking Pharmacists to interact more with patients and offer consultative advice on managing their condition. Is this welcome?

This initiative might encourage patients to take more control of managing their condition themselves and rely slightly less on their GP for simple things. Please make any comment.

[flowerpower21]

Hello PBirt, very interesting question. For me, I think I am very lucky in the fact that all the medical professionals I deal with being on warfarin are all supportive. My doctor took up my case with the Dudley PCT regarding the supply of test strips for self-testing and this has finally been granted - it took us two years to get this far! My anticoag support at my hospital are wonderful too and have taken great effort and time in supporting those of us who have taken on the self testing freedom! Both my doctor and hospital support know that I took the self testing route because of the inconvenience that comes with fitting hospital appointments in while working full time and needing to not lose out on pay while attending hospital - not everyone has the support of a permanent job - alot of us work as temps! As for my chemist they have such close ties with our local surgeries that I have even rang the local chemist for advice when the doctor surgery is shut. I hope that a lot more pharmacists will be able to participate in guidance and assistance for our fellow anticoag patients.

[success]

The pharmacist can play a critical role in supporting people and I recently had an excellent experience when seeking advice around a eye problem which negated the need to see the GP and didn't involve having to buy over the counter meds.

With regard to warfarin users, having been on warfarin for many years, I have never been asked by a pharmacist for my current INR results when submitting a prescription or, advice on how to take the meds. I believe pharmacists can greatly add to the education and advice to help support patients taking anticoagulants especially around how the drugs should be stored, potential interactions and general advice as to any reaction they may experience when starting the treatment and the importance of reporting any adverse reactions to their GP. With the new oral anticoagulants now available, patients could benefit from the additional guidance on the most effective ways to take these treatments as compliance is so critical to the effectiveness due to the duration of time they work on the body(half life) I am sure that there will be people who have built good relationships with their pharmacists over the years and this arrangement complements their GP service effectively. Any pharmacy led consultation process will require adequate training in effective patient engagement (communication and soft skills) with resources such as consultation areas for patient privacy. This work is already underway with pharmacists working closely with patients on quit smoking programmes( assume some incentivisation from the DoH)

Monitoring outcomes for such arrangements will need to involve patient feedback in a measure which is not onerous on either party but effectively collects the data. Perhaps a friends and family type measurement system would work in this environment?

[Tipper]

I've been asked a few times over the last two years or so what my INR is, when it was last tested and did I understand what it was all about? When I say that I tested myself within the last week, what my INR is, my target range and that I 'self-manage' they rapidly lose interest!

But full marks for asking because I suspect there are many, probably older than me (and I'm 62) who don't know or understand what it's all about because that 'nice man/woman at the surgery/clinic' tells them what to do. I believe in taking control over my own medical condition as after all it affects me the most and only I know what my body is telling me. I'm not really sure my GP knows much about ACT either, he never asks what my INR is and how well I am maintaining my target range. I ususally tell him anyway but he seems uninterested in my spreadsheet graph of results. Self testing is a great comfort and allows travel without worries.

Of more concern is the rapidly changing pharmacist count at a certain well known large chemist shop here in the UK! Seems to be a different pharmacist every time I go and no way a meaningful relationship with the dispenser of my medications can be achieved.