Pharmacies use data to target CVD need in the community

A recent pilot project harnessing the Community Pharmacy Blood Pressure Check Service to target patients has helped to embed pharmacies in local care pathways, Surrey & Sussex LPC chief Julia Powell has told P3pharmacy

Powell says that when the case finding scheme was launched in October 2021, system partners “were looking at how we could maximise use of that... and pick up more patients that are currently undiagnosed”. 

“There were a number of conversations around digital platforms,” she says. “We identified that we could use AccuRx to support targeting a cohort of patients identified by the GP practice or primary care network.

“What we then looked at were those patients who had a high blood pressure reading on the system, but were not on the hypertensive case finding register, as well as patients who had not had a blood pressure check in five years.

“Once that cohort was identified, we then tried to find the best way to target those patients utilising community pharmacy.”

Pilot sites

The scheme started with “small pilot sites”, principally in Sussex, where there was more detailed patient data because of a previous study.

“We were keen to ensure the capacity of the community pharmacies to be able to do the blood pressure checks,” says Powell. “For example, across Bexhill PCN, around 2,000 patients were identified. We looked at pharmacies near the GP practice who were live with the service, and considered the capacity they could cope with each week.

“The pilot focused on text messaging, with pharmacies sending 25 texts per week – with four pharmacies, you have around 100 text messages. By doing it this way, we at the LPC could ensure the number of texts matched pharmacies’ capacity, and we were monitoring it each week so we could change the target so they weren’t overwhelmed.

“They were then asked to get feedback about whether they’d picked up a patient and then done the 24-hour ambulatory reading if it was high, then asked to get feedback about what happened as a result of that.

“Often with community pharmacy, we do a service and signpost the patient to somewhere else for the investigation – you don’t always get the feedback they’ve been treated and you’ve successfully helped a patient.”

Community Pharmacy Surrey & Sussex deputy chief officer Marie Hockley told P3pharmacy: “In the pilots we sent out a total of 2,683 messages with 57 per cent of patient responding to the messages. 77 patients had a new diagnosis of hypertension that was then managed by their GP as a direct result of this pathway.

“As the pilots were so successful, we have rolled out this work to nine PCNs and 38 practices so far this year and this is increasing.”

The feedback from participating pharmacies was positive, Ms Powell says, as the pilot was tailored to workload and offered tangible benefits to patients. “Obviously, surgeries have found the service useful too, because everything is getting coded back,” she adds.

The project involved close cooperation between LPC deputy chief officer Marie Hockley and Dr Suneeta Kochlar, who leads on CVD for Sussex ICB. “It was a very collaborative approach,” says Ms Powell.

While the LPC has a history of forging ties with CCGs and PCTs, Powell says the devolution of powers to ICBs has helped pharmacies move beyond the traditional discussions around medicines management.

Focus and awareness

“We were seen as part of primary care much more than we have been previously,” she says. “Now the management of the contract sits within the ICB, I think there’s a lot more focus on and awareness of what community pharmacy can offer.”

Are there other services where a similar approach could be used? “There are a few things we’re in discussion over, things like treatment for simple urinary tract infections using a PGD.

“The other big thing – I think again this is because of the ICB structure – is using the Pharmacy Quality Scheme as a valuable resource to really integrate pharmacies in with the GP practices.

“But the biggest issue at the moment in terms of digital integration is that most of the GP practices can’t communicate very easily with pharmacies; even within community pharmacy, different dispensing systems don’t communicate very well.

“Particularly looking at independent prescribing moving forward, we need to be able to link up some of our digital systems – we need that read/write access so GPs are aware of prescribing decisions and we can access shared care records.”