Community Pharmacy Pilot in Aberdeenshire: Enhancing Access to Treatment
Aberdeenshire Community Pharmacy is piloting a program to improve access to treatment, focusing on providing opioid substitution therapy and Buvidal injections. The initiative aims to increase equity of access, reduce missed administrations, and support specialist service workload. Requirements for pharmacists include specific training and documentation, while specialist service staff will provide support and guidance for successful implementation.
- Community Pharmacy Pilot
- Aberdeenshire
- Buvidal Injections
- Opioid Substitution Therapy
- Specialist Service
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Aberdeenshire Community Pharmacy Buvidal Pilot LUCY SKEA : lucy.skea@nhs.scot SENIOR PHARMACIST SUBSTANCE AND MEDICINE USE NHS GRAMPIAN, ABERDEENSHIRE Fiona Gray : Community Pharmacist, Wills Chemist Inverurie
Why Community Pharmacy? Community Pharmacy staff are used to supplying and monitoring Opioid Substitution therapy (OST) for patients. Already have Home office license and safe storage facilities for Controlled Drugs. Pharmacies are at the heart of peoples communities Many Community Pharmacists are already trained to provide flu and travel vaccines and have consultation rooms with the necessary clinical facilities. Most Pharmacies open 6 days a week Many already have close working relationships with Specialist service To increase equity of access to treatment across Aberdeenshire
Community Pharmacy Pilot: 2021 The aims were to make access to LAIB more equitable and easy for patients To support specialist service workload and reduce the potential for missed administration and subsequent default from treatment. March 2021 prescribing guidelines approved in NHS Grampian Developed required Pathway for Community Pharmacy and associated documentation which included: Patient specific direction (PSD) this is the instruction from the prescriber to allow the Pharmacist to administer injection Patient consent form to show the patient happy for pharmacy to administer treatment NHS service level agreement (SLA)& standard operating procedure (SOP)
Requirements of Community Pharmacists in Pilot Pharmacies Anaphylaxis training and basic life support training completed and up to date Pharmacists need to have already completed vaccination training Training provided on Buvidal to include Pharmacology along with specific administration requirements of the sub-cut depot Face to face training and supervision of first few administrations by another member of SMS clinical team already experienced in administering buvidal. Minimum of two trained pharmacists per pharmacy, this is to allow for holidays, sickness etc. and provide cover to make sure administrations can happen, need not be present at same time. Indemnity Insurance (policy must state that buvidal administered) Sign Service Level Agreement (SLA) with Pharmaceutical services NHS Grampian to provide buvidal
Requirements of Specialist Service Staff for pilot. Provide support and opportunities for pharmacists to shadow clinics and injection of buvidal Provide information to the Community pharmacy in advance for any new patient who has consented to treatment at pharmacy Provide Prescription for Buvidal along with Patient Specific Direction in a timely manner to allow time for ordering of stock and time for pharmacy to contact patient with suitable appointment time Inform Gp practice that patient will be /has been commenced on Buvidal Continue to review and Assess the patient at appropriate times and if requested by community pharmacy if missed doses or if concern identified.
Community Pharmacies in Pilot (patient numbers Jan 23) Five community pharmacies in Aberdeenshire were selected to participate Training began in July 21 with first administration between Sep 21 and Dec 21 Davidsons Banchory (2) Wills Chemist, Inverurie (5) Buchanhaven, Peterhead (5) Largues, Huntly (1) Strachan's, Banff (8) 4 independents and one from a small chain
Independent Evaluation of Community Pharmacy Pilot (due out soon) Supported by MAT standards implementation (MIST) and MIST Q (tasked with ensuring lived and living experience are core to any development) teams Evaluated a selection of Specialist service staff, Community Pharmacists and Patients themselves, interviews were carried out independent of NHS Grampian From responses given, only areas for improvement was the time from delivery of training to first administration of LAIB (which was felt to be too long for some of Community pharmacists) and more training on patient assessment if restarting a LAIB
Early info from Evaluation All participating pharmacists reported that their relationship with patients who they administered LAIB to had changed in a positive way with better communication and relationships, happier to attend the pharmacy, less stigma and a more positive and rewarding service for both. A concern raised by specialist service staff ahead of the test of change was the likelihood that patients would reduce their engagement with the service if not coming for their injection. This was not the case during the period of the test of change. The only additional comment recorded here was positive ...this actually improved engagement and available time to discuss other things than administering medication . One patient is in full time work. Pharmacy administration allows him to make appointments on a Saturday which saves him having to take ask for time off from work for appointments during the working week.
Community Pharmacist Experience of running buvidal clinic Fiona Gray Community Pharmacist Wills Chemist, Inverurie, Aberdeenshire
References Guidance For Prescribing And Administering Buprenorphine Subcutaneous Injection In Grampian (nhsgrampian.org)