Supervision in community pharmacy report published
The Supervision Practice Group, which comprises community pharmacy, pharmacist and pharmacy technician representative organisations, has published a report on how supervision in community pharmacy policy meets practice, and how legislation, regulatory rules and standards, and professional standards and guidance can facilitate this changing role. The aim is to enable enhanced patient access to the pharmacist while improving safety.
The report provides a framework with which the Department of Health and Social Care and the regulators can draft specifically worded revisions to legislation and regulatory rules and standards.
The report says legislation provides safeguards in terms of medicines preparation, assembly, sale and supply, but does not focus on the safe use of medicines. The group believes that any changes to legislation ‘must continue to prioritise patient safety, enhance the delivery of pharmaceutical care and at the same time be responsive to patients’ and health system needs’.
It adds, ‘If the profession has an ambition to adapt and evolve in the future, to take advantage of a developing healthcare landscape, then legislation needs to be enabling. In the context of “supervision” this means that in most cases legislation should define principles with regulatory rules and standards and professional standards and guidance providing the detail.’
The full report can be found at: https://thecca.org.uk/wp-content/uploads/2023/07/Supervision-in-community-pharmacy-report.pdf.
New studies shed light on the potential risks of antenatal steroids
Two new studies published in the BMJ have examined the potential health risks for infants of giving steroid drugs to women who are at risk of giving birth early. The authors say that, taken together, the results of the studies highlight the need for health professionals to be aware of the potential risks and to exercise caution when considering antenatal steroid treatment.
Babies born early (preterm) carry a greater risk of death and serious complications, such as breathing difficulties, bleeding into the brain, and infection than babies born at term. These problems tend to be more severe the earlier the baby is born.
Corticosteroids are known to help increase the chance of a baby born early surviving and having fewer health problems. Ideally, they should be given before 34 weeks of pregnancy and within approximately 1 week of birth.
Their effects on later childhood health are less well understood, particularly when administration is ‘mistimed’ and infants are born at term.
Two studies set out to fill this knowledge gap.
The first is based on data from the National Health Insurance Research Database in Taiwan for nearly 2 million children born between 2008 and 2019. It shows that exposure to antenatal corticosteroids compared with no exposure is associated with an increased risk of serious infection, including sepsis and pneumonia, during the first 12 months of life. Further analyses suggest the increase in risk of serious childhood infection is greater for infants born at term than for those born preterm.
The authors acknowledge that these are observational findings so no firm conclusions can be drawn about cause and effect, and that further investigation is needed to replicate the findings in other populations.
However, they say: ‘Clinicians need to be aware of the increased risk of rare but serious infection among children exposed to antenatal corticosteroids.’
The second study, based on data from seven randomised controlled trials and 10 population studies involving 1.6 million infants born since 2000, shows that around 40% of infants treated with antenatal corticosteroids are born at term.
For these children, exposure to antenatal corticosteroids was associated with an increased risk of short- and long-term health issues, such as admission to neonatal intensive care, breathing problems, and reduced growth.
The researchers recognise that drawing firm conclusions about the impact of antenatal corticosteroids on later health is difficult as findings were mainly from observational studies, with low or very low certainty evidence, and more follow-up of randomised studies is important.
Nevertheless, they say caution might be warranted when using antenatal corticosteroids. They call for better prediction tools for preterm birth and enhanced criteria for the administration of antenatal corticosteroids, along with a less liberal approach to the use of antenatal corticosteroids.
Greater use of over-the-counter medicines could save the NHS £1.7 billion annually
Encouraging people to take a more proactive approach to their health and increasing appropriate use of over-the-counter (OTC) medicines could save the NHS £1.7 billion a year, according to a new report commissioned by the Proprietary Association of Great Britain.
It is calculated these savings would come from eliminating 25 million unnecessary GP appointments and 5 million avoidable visits to A&E.
There would also be an additional economic windfall of £350 million annually as a result of employees not having to take time off for avoidable NHS appointments. The new analysis is detailed in The Economic Impact of Over-The-Counter Medicines in the UK report.
Greater OTC use could unlock even more of these benefits. Eliminating appointments for self-treatable illnesses and enabling greater use of existing OTCs instead could save the NHS at least £1.7 billion per year and reduce workplace absence.
‘Reclassification of prescription-only medications to OTC status represents another opportunity to widen self-care and stimulate greater OTC use, generating further benefits for the NHS and the economy. Policymakers should recognise the importance that self-care and OTCs play in the UK today and acknowledge the sizeable benefits that greater OTC usage could bring. Eliminating unnecessary NHS treatment for minor illnesses and enabling greater use of existing OTCs would have a clear impact’, say the authors. They add that widening access to OTC products ‘via reclassification of suitable candidate drugs is another possible avenue to unlock further potential in the OTC markets that policy makers could consider’. The full report can be found at: https://www.pagb.co.uk/content/uploads/2023/07/20230712-Frontier-PAGB-OTC-Impact-Report-v1-0.pdf.
Patient-directed financial incentives may improve asthma management behaviours
A new study has found some evidence that patient-directed financial incentives improve asthma management behaviours. The objectives of this systematic review, published in the BMJ Open, were to identify studies that assess the effectiveness of patient-directed financial incentive interventions to improve asthma management behaviours, determine overall effectiveness of financial incentives, identify design characteristics of effective interventions and assess the impact on longer-term outcomes in the context of asthma. The researchers identified 4268 articles, of which eight met the inclusion criteria. The studies were from the USA (n=7) and the UK (n=1).
Asthma management behaviours included attendance at appointments (n=4), reduction in smoke exposure (n=1) and medication adherence (n=3). Studies that showed significant improvements in asthma management behaviours used positive gain and certain, fixed financial incentives of smaller magnitude, given for all instances of behaviour. Interventions were predominantly multicomponent, and financial incentive design was diverse, making it difficult to draw conclusions on what financial incentive characteristics were most effective. The authors conclude that further research is needed to establish intervention design and to assess impact on clinical asthma outcomes. Cost-effectiveness assessments would be a useful additional parameter to help determine policy and practice.