Community pharmacies may be able to identify cases of undiagnosed chronic obstructive pulmonary disease (COPD) in its early stages, which could lead to more than $415 million in healthcare cost savings, according a report by the University of East Anglia (UEA), in Norfolk, United Kingdom. The research revealed the capacity of pharmacies to aid in diagnoses could not only lead to substantial savings for British National Health Service (NHS) and other healthcare industries worldwide, but also could improve patient outcomes.
With approximately 2.7 million people living in England with undiagnosed COPD, the researchers focused on early detection of the disease and reduction of lost productivity costs, concluding that the NHS may save £264 million ($415 million) annually by implementing the program in 11,100 pharmacies throughout England. The researchers also estimated that additional lifetime savings from stopping smoking are £215 million, or $339 million.
“Our evidence from this service evaluation shows that case finding of COPD patients by community pharmacy is possible. Targeted screening identifies one patient with moderately severe COPD risk for every two who are screened,” explained David Wright from the UEA’s School of Pharmacy and lead researcher of the study, which was recently published in the International Journal of Pharmacy Practice.
“A simple cost analysis based on the smoking cessation element alone suggests that providing the cost per patient screened is less than £400 [$640], then the service should be adopted by the NHS because the costs are less than the current model of doing nothing,” the researcher added.
The research team analyzed data from 238 people that had been screened at 21 pharmacies on the Wirral Peninsula. More than half of them, 57%, were classified by the pharmacy at higher risk of COPD, which equated to 88 people. In addition to screening, the pharmacies offered advice about smoking cessation, which had declined by 39% among the patients. A fifth group, 18% of the patients, accepted the pharmacy-based services and 34% were referred to another type of support to quit smoking.
Other general lifestyle recommendations were offered to 63% of the patients screened, on topics such as smoking, in 41% of the cases, diet and nutrition to 13% of them, on physical activity to 21%, alcohol consumption to 7% of them, and on weight management to 5% of the patients.
“Our work has shown that pharmacies are an ideal place to undertake COPD case finding,” stated the head of external affairs at Lloydspharmacy and a member of the project’s management committee, Clare Kerr. “Our work complements that of GPs, as many of our customers are not in regular contact with other health services. It uses the whole pharmacy team to identify the most appropriate people for screening and delivers significant benefits for the NHS and society as a whole, as a result.”
“We have also demonstrated that this service can be delivered by pharmacies in a wide range of settings. We are very pleased that this work has resulted in a robust addition to the evidence base supporting the commissioning of services from community pharmacies,” Kerr added.
Patients were identified for the screening by the pharmacy teams by their smoking status, frequency of medication purchases (namely for the treatment of cough), as well as for chest infection exacerbations, which is an assessment that is difficult to make in other healthcare settings. After being identified, customers were asked to complete a risk assessment questionnaire and had a microspirometry test. Patients classified as high risk were referred to GP, and offered additional lifestyle recommendations.
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