Here we are again, 2020 and the fourth Ask About Asthma campaign. After reporting our successful Interactive Inhaler Technique Training Workshops at last year’s campaign, I had been expecting to write about a new collaborative respiratory review service which was to include a provision for children and young people with asthma. Who would have thought that when we ushered in the new decade we were also ushering in an “unprecedented” period of rapid changes…rapid changes in attitudes, inter-actions, communications and work practices, unfortunately putting the brakes on non-Covid service development and research.

Changes in communication and work-practice became glaringly evident with Community Pharmacy the only face-to-face health care provider readily accessible to the general public.

The highly dedicated health care teams of Community Pharmacy rose to the challenge of the unfolding drama. Social distancing, constant cleaning, increased hours and workload, stock shortages, staff shortages due to sickness and medicine deliveries to name just a few of the issues faced.  But pharmacy proved itself resilient to be both present and forward thinking, adapting premises and services to the needs of its community whilst maintaining the safety of its staff.

The nature and severity of Covid-19 respiratory symptoms highlighted the importance of establishing good respiratory control for those with asthma and COPD. With a sudden increase in demand for preventer treatment, Community Pharmacists liaised with LPCs, Primary Care and CCGs, working tirelessly to ensure continued supply of required inhaler devices. With many Community Pharmacy consultation rooms temporarily out of action and the risk implications of conducting inhaler technique checks in the pharmacy, Pharmacists supplied information literature and directed patients to websites and apps.  Pharmacies lucky enough to have video technology available could monitor patients remotely, although not as part of a commissioned service.

With the attitude of “a glass half full” and understanding the need for services to adapt, Community Pharmacy is embracing new technologies to enhance service delivery. The Middlesex Group of Local Pharmaceutical Committees is investigating the use of video consultation platforms in Community Pharmacy. We are awaiting the results of a survey into the public’s views on using Community Pharmacy video consultations and if positive, we would like to drive a change in service specifications to enable commissioned remote Community Pharmacy reviews for those patients unable to attend in person.

Asthma reviews, particularly for children and young people, would be suitable for remote consultations. For patients with long-term conditions including asthma, Community Pharmacies often have six patient-prescription contacts over a twelve-month period. Community Pharmacy could comfortably complement, not duplicate, the asthma work being carried out by community asthma nurses, primary and secondary care. Draft plans were under discussion for a commissioned Community Pharmacy Respiratory Review Service. In the light of Covid-19 the service specification could re-worked to enable a remote review if prescription items have not been collected in person, greatly significant for vulnerable patients. Inhaler technique can be assessed, assisted by prescribed training devices which can be attached to certain inhalers and spacers. Pharmacist, caregiver and patient can hear if the inhaler is being used correctly during review. This is especially useful for children and young people to reinforce good device technique and instil understanding early on. Community Pharmacists can encourage the use of fun new interactive children friendly apps and websites, to help improve and maintain good inhaler technique.

Reviews are also an ideal time to impart healthy living advice. For the teenagers and those a little older, a discreet respiratory review can provide an opportunity to discuss other matters including healthy lifestyle, mental health and sexual health.

To the Future

Covid-19 has shaken the foundations of us all, but we are lucky to have a health care system which has quickly adapted to the current needs. We are especially lucky to have innovative and motivated Community Pharmacists and healthcare teams who have worked and are still working so hard to ensure that our communities, and particularly those who find it difficult to access services, are well looked after and stay safe and healthy during this difficult time.

We look forward to the incorporation of new technologies to enhance the Community Pharmacy role as most accessible health care providers and hope that in the near future, this is reflected in new relevant commissioned services.

Definitely “a glass half full”!

By Marsha Alter
Community Pharmacist and team member of the Middlesex Group of Local Pharmaceutical Committees