Dr Timothy Harries is a GP and Clinical Lecturer in the Department of Population of Health Sciences at King’s College London. He was among our first Ignition Fund awardees in 2024 and used the funding to test the feasibility of a community pharmacy blood test for COPD, which will inform a larger study. He says, “This study has provided a valuable insight into the feasibility of potential enhanced collaborative working between community pharmacists and general practitioners in improving the care of patients with exacerbations of COPD.”
You can read Tim’s report here:
Improving safety and TReatment precision for Acute COPD Exacerbations (TRACE): Feasibility of point-of-care blood testing in community pharmacies. A qualitative study.
Acute COPD exacerbations (AECOPDs) account for over 11% of primary care antibiotic prescriptions and up to 40% of patients receive repeated oral corticosteroids (OCS).1,2 Adverse effects include antimicrobial resistance (antibiotics) and fractures, diabetes and osteoporosis (OCS). Without objective markers, prescribing decisions rely on symptoms and examination, without test corroboration. 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 and OCS by 22% and 33% respectively, without harm.3,4 This study, undertaken by researchers at King’s College London and supported by a Vivensa Ignition Award, aimed to explore the opinions of community pharmacists, general practitioners (GPs) and practice nurses of the feasibility and acceptability of POCT COPD assessment in pharmacies.
Semi-structured interviews (pharmacists, GPs, practice nurses) were undertaken to determine the facilitators and barriers to implementing POCT COPD assessment within community pharmacies. Interviews were audio-recorded and transcribed verbatim for coding and inductive thematic analysis.
20 participants (11 pharmacists, 8 GPs, 1 nurse) in London and Kent were invited and agreed to be interviewed. Participants’ clinical experience ranged from 6 months to 40 years. They were recruited via Integrated Care Boards, Local Pharmaceutical Committees and support groups for community pharmacists.
All participants supported the intervention and its feasibility. Pharmacists were enthusiastic about expanding their clinical scope and felt confident that 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 of the intervention included patients’ preconceived ideas of their need for COPD rescue packs, the inconvenience for patients of visiting the pharmacy when they felt unwell, the 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 included patient education (required patient behavioural changes), clinical demand (time and pharmacist reimbursement), and communication (data sharing/storage, safety-netting).
In conclusion, pharmacists, GPs and practice nurses support the development and implementation of a POCT COPD assessment pathway in community pharmacies, potentially improving patient medication stewardship.
The Ignition Fund provides flexible funding of up to £5k, for Academy members only.
References:
1 Rockenschaub P, Jhass A, Freemantle N, Aryee A, Rafiq M, Hayward A et al. Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD). J Antimicrob Chemother 2020; 75: 243–251.
2 Sivapalan P, Lapperre TS, Janner J, Laub RR, Moberg M, Bech CS et al. Eosinophil-guided corticosteroid therapy in patients admitted to hospital with COPD exacerbation (CORTICO-COP): a multicentre, randomised, controlled, open-label, non-inferiority trial. Lancet Respir Med 2019; 7: 699–709.
3 Butler CC, Gillespie D, White P, Bates J, Lowe R, Thomas-Jones E et al. C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. N Engl J Med 2019; 381: 111–120.
4 Ramakrishnan S, Jeffers H, Langford-Wiley B, Davies J, Thulborn SJ, Mahdi M et al. Blood eosinophil-guided oral prednisolone for COPD exacerbations in primary care in the UK (STARR2): a non-inferiority, multicentre, double-blind, placebo-controlled, randomised controlled trial. Lancet Respir Med 2024; 12: 67–77.