Case Study: Horsham Amcal Pharmacy
Pictured From Left to Right: Lynn Lockett, Emma Nikkerud, Tony Girgis.
Lynn Lockett and her team at the Amcal Pharmacy in Horsham were part of a COPD pharmacy service trial in 2014 run by the Grampians Medicare Local and Lung Foundation Australia. The trial was so successful Lynn decided to continue the service for her customers. Read Lynn’s story for great tips on how to make a difference in your community with a COPD pharmacy service.
What motivated you to start a COPD service in your pharmacy?
Our pharmacy was involved in a trial in 2014 run by the Grampians Medicare Local in conjunction with Lung Foundation Australia, after our community was identified as having a high incidence of COPD.
Initially we had three pharmacists and one nurse involved in the trial and we all did extensive training prior to the trial commencing. The trial was very successful in creating conversations about lung health and identifying patients at risk. It was very obvious to me we should continue to offer the service for the benefit of our business and the community.
What services do you provide and how do you identify patients?
Our current service involves a 15 minute consultation including a risk assessment COPD screening test using the PiKo-6.
We approach people with known risk factors identified via the script medications they purchase or if they are purchasing nicotine replacement therapy. We can also often identify potential candidates for screening through general conversation with the customer.
Depending on results from the screening we either send them to the GP with a referral letter or make a note in their dispense history to approach them to repeat the test in 12 months’ time.
In general we get a good response from most customers but some are not receptive. We try to approach those people again 6-12 months down the track.
How do you involve other members of the pharmacy in the service?
We were lucky to have three pharmacists involved from the very beginning due to the trial. We were all very well trained and rotated running the service on a regular basis. Now that the trial is finished it is easy to become complacent or caught up in other aspects of the business and the service can fall by the wayside. It is therefore absolutely necessary to have a staff member champion the program and drive it.
What equipment and/or resources did you access prior to commencing the service?
We use the Lung Foundation information pamphlets for patient interaction. Initially we used the instructions for the PiKo-6 device and results sheets which were very valuable.
The Lung Foundation Australia COPD Online Training was very extensive. It took quite some time for the pharmacists to complete it but extensive training means you are better prepared to run the service.
What would you identify as barriers to success?
Resistant customers are a barrier. Some people have their heads buried in the sand. On the flip side we have many great success stories. One customer absolutely refused to go to a doctor despite presenting with symptoms that could have been related to lung disease. He came into the pharmacy and we managed to convince him to do the COPD screening test. He had been a smoker and currently worked in a workshop environment that wasn’t particularly clean. He did the test and we immediately referred him to his GP. He came back with scripts for COPD, blood pressure and cholesterol which ended up being a great long term result for the patient.
Price: It takes time for the pharmacist to do the screening. Our pharmacists’ time costs money and, as a business, we need to see a cost benefit. That means in the long term we need to charge for services. In the past the remuneration we received for dispensing covered the cost of providing free services. But unfortunately that funding has been cut and we need to start charging for services.
The challenge is that customers are very negative about paying for services because they believe everything from pharmacy should be free because it always has been. This is a huge challenge moving forward and is a dilemma for us at the moment. It is frustrating because the long term benefits of doing the screening are enormous from a health and cost perspective – when you consider what it would cost the health system if a patient went undiagnosed, developed chronic lung disease and required care. It would be good to see Government funding for a Medicare number for pharmacists to do COPD health screening.
What advice would you give to other pharmacist starting a COPD Pharmacy service?
Use the resources from Lung Foundation Australia. Ensure you do the online training to have a thorough understanding of the disease and the screening process. Buy the PiKo -6 device and learn how to use it.
World COPD Day is in November, so this is a good month to start running a service and to approach people. It is worth noting that patients should be replacing their Spiriva handihaler every twelve months. November is a good month to encourage this as many current patients with pension and concession cards will have reached the free status for medication so they can afford the cost of a replacement handihaler.