Improving safety and TReatment precision for Acute COPD Exacerbations (TRACE): Feasibility of point-of-care testing in community pharmacies. A qualitative study. (ID 633)
King's College London
Abstract
Background and aim
Acute COPD exacerbations (AECOPDs) account for 11% of primary care antibiotic prescriptions & up to 40% of patients receive repeated oral corticosteroids (OCS). Without objective markers, prescribing decisions rely on symptoms and examination. Drug rescue packs are usually issued without clinical assessment and obtained directly from pharmacists. Use of point-of-care blood tests (POCTs) of CRP and blood eosinophil count can decrease prescriptions of antibiotics & OCS by 22% and 33% respectively, without harm. This study aimed to explore the opinions of community pharmacists, GPs and practice nurses of the feasibility and acceptability of POCT COPD assessment in pharmacies.
Methods
Semi-structured interviews (pharmacists, GPs, practice nurses) were undertaken to determine the facilitators & barriers to implementing POCT COPD assessment within community pharmacies. Interviews were audio-recorded and transcribed verbatim for coding and inductive thematic analysis.
Results
20 participants (11 pharmacists, 8 GPs, 1 nurse) in London and Kent agreed to be interviewed. Participants were recruited via Integrated Care Boards, Local Pharmaceutical Committees and support groups for community pharmacists. All supported the intervention and its feasibility. Pharmacists were enthusiastic about expanding their clinical scope and felt confident it fitted their current role. POCTs are established in community pharmacies. GPs and nurses were willing to support the pharmacists. Proposed benefits of the intervention included a decrease in unnecessary prescribing, the reassurance for patients and clinicians that would be obtained from objective results, the empowerment of patients and improvement in self-management of COPD, professional recognition of pharmacists’ clinical role, and an increased accuracy in the recording and monitoring of drug rescue packs. Potential obstacles to implementation included patients’ preconceived ideas of their need for rescue packs, inconvenience for patients of visiting the pharmacy when they felt unwell, limited knowledge among patients of the adverse effects of rescue pack medication, and patients’ reluctance to change their health-seeking behaviour. Key context implementation factors: Patient education (required patient behavioural changes), Clinical demand (time & pharmacist reimbursement), Communication (data sharing/storage, safety-netting).
Conclusions
Pharmacists, GPs and practice nurses support the development and implementation of a POCT COPD assessment pathway in community pharmacies, potentially improving patient medication stewardship.
Funding: Funded by a Vivensa Academy Ignition Award
Conflicts of interest: None
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