Additional information

These documents and the activities they describe were created and certified as compliant with all codes, regulations and laws in force during the period of time from their creation to completion. By accessing the documents within this archive library the reader acknowledges and accepts any differences that may exist between the standards and practices required today and those that were adhered to at the time when the activities and documents were certified.

Ashford Clinical Commissioning Group
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Improving asthma outcomes in Ashford Clinical Commissioning Group via a Medicines Use Review

A Joint Working Case Study between Ashford CCG and Teva UK Limited

Download the joint working case study >

This is an example of how Ashford Clinical Commissioning Group (CCG) worked on a local joint working project with Teva UK Limited to deliver an MUR support programme, which included inhaler technique training, Medicine Use Review (MUR) training and other support services.

Project Rationale

Long-term conditions, including respiratory illness and asthma, featured in Ashford CCG’s 2013-14 plans and priorities.

Medicines Use Reviews (MURs) provide pharmacists with the opportunity to influence patients’ knowledge and adherence to treatment.

The joint working project was envisaged to help support and train surgery healthcare professionals (HCPs) and community pharmacists on inhaler technique to a consistently high standard.

Desired Outcomes

The objectives of this joint working project were:

1. Improve the education and experience of asthma patients as measured by a patient questionnaire
2. Train surgery HCPs and community pharmacists on inhaler technique to a consistently high standard as measured by them completing accredited training
3. Improve the volume, quality and delivery of asthma MURs as measured by pharmacy and patient questionnaires
4. Improve liaison between practices and pharmacy as measured by collective stakeholder feedback

Joint Working Project with Teva UK Limited

In order to achieve these outcomes, Ashford CCG worked in collaboration with Teva UK Limited as they provided:

• Project management and support of communication between pharmacy and practices
• Experience of delivering medicine use reviews through sponsoring the provision of National Service for Health Improvement (NSHI) to deliver an MUR support programme
• Teva UK Limited co-ordinated the project and provided a source of contact for all stakeholders involved

Both Ashford CCG and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice.

Methodology and approach agreed

Outcomes achieved

Following the initial mailing to patients, the response to the MUR invitation was an attendance rate of 5% (24 patients).

With agreement from the practice and pharmacies taking part in the project it was agreed that an additional mailing would take place with the objective of increasing attendance. The final attendance was 6% (33 patients).

At the time of MUR, the pharmacist identified the following:

• 21/33 (64%) patients had issues highlighted that required attention
  • 15/21 (71%) had poor asthma control
  • 10/21 (48%) were not using their medication as prescribed
  • 5/21 (24%) were overusing their B2 agonist
  • 16/21 (76%) had poor inhaler technique
  • 9/21 (43%) had asthma that effected their daily living

• 18 (54%) patients seen by the pharmacist were advised to book an appointment with their Practice Nurse for a further review, as a result of issues associated with poor asthma control identified at the time of their MUR (of these, 10 patients attended a further review).

MUR Patient feedback

• All 33 Patients (100%) completed a questionnaire, evaluating the MUR experience immediately after their review.
• Results were very encouraging and showed that:
  • 67% of patients felt that they knew more about their asthma and their medicines
  • 79% of patients felt that as a result of attending the MUR they had a better understanding of how to use their medicines
  • 76% felt more confident in using their inhalers correctly
• 21 patients (64%) noted that they would do something differently as a result of their MUR. Changing how they would use their inhalers was a frequent response.

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy. A consideration for future projects will be to ensure greater engagement with pharmacists to improve both patient recruitment and project outcomes.

Joint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care¹

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References

[1] Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008

NHS Bristol
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Reducing asthma hospital admissions across NHS Bristol

A Joint Working case study between NHS Bristol and Teva UK Limited

Download the joint working case study >

Project rationale

NHS Bristol identified there were 79,794 emergency hospital admissions for asthma in the UK in 2008-09 with an estimated 75% being avoidable.1 During that time, around 600 people were admitted to hospital as a result of their asthma, with four deaths in Bristol alone.

NHS Bristol wanted to improve asthma management to reduce asthma hospital admissions. 

Local challenge

Previous audits had identified:

• Variations in asthma management across GP practices with some practices providing annual asthma reviews to 73.3% of their asthma register, and others only 36.4%;
• Variation in admissions of between 0.2% and 6.9% of the asthma register;
• On average, only 20.8% of asthma patients have been provided with an asthma self-management plan (SMP). If patients were better informed on how to manage their asthma symptoms, it is likely that many of these admissions could have been prevented;
• Exception reporting data for Quality and Outcomes Framework Asthma highlighted that as much as 38.3% of asthmatics in some practices were being exception reported rather than reviewed.

Agreed objectives

The objectives for the project were aligned to QIPP:

Resource split

Outcomes achieved

Reduction in hospital admissions

There was a 19.46% reduction in asthma admissions in 2011/12 in Bristol (n=56) compared to the previous year. Practices participating in the IMPACT programme accounted for 54.7% of this (n=13).

Positive patient reported outcomes

Results from the IMPACT service patient evaluation showed that patients felt more confident in managing their asthma and that they were using their inhalers correctly following a structured asthma review.

Question (‘Strongly agree’ or ‘Agree’)

• I would recommend this asthma review to others - 96%
• I will attend a yearly asthma review at my surgery - 95%
• I am very satisfied with the asthma review I received - 98%
• I am more confident in managing my asthma - 93%
• I know what to do if my asthma gets worse - 97%
• I now feel confident that I can use my inhalers correctly - 95%
• I now know more about my asthma - 85%
• During the review I was allowed to say everything that I thought was important - 99%
• The asthma review was useful - 95%

In alignment with QIPP, NHS Bristol succeeded in improving asthma management to reduce (prevent) asthma hospital admissions. Benefits included:

Wirral Health Commissing Corsortium
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Improving asthma outcomes in the Wirral Health Commissioning Consortium (WHCC): A 12-month re-audit

A Joint Working Case Study between WHCC and Teva UK Limited

Download the joint working case study > 

This is a case study of how Wirral Health Commissioning Consortium (WHCC) worked in a local joint working initiative with the Integrated Healthcare Manager from Teva UK Limited to improve asthma outcomes in registered practices. 

Project rationale

According to the Practice Level Register as of the 1st April 2012, WHCC had 10,897 patients with a diagnosis of asthma. The average prevalence rate is 6.6% compared to a UK average of 5.6%. WHCC identified that over the last three years the annual average number of non-elective emergency admissions for WHCC was 255, with an approximate cost of £379,000.

WHCC wanted to explore innovations and best practice with the aim of improving asthma outcomes for patients registered to the WHCC practices.

This real-life case study compares the results of the baseline audit to the outcomes of the 12 month re-audit.

Desired Outcomes

The objectives of this joint working initiative were:

1. To improve the clinical management and therefore the outcomes for patients over the age of 12 within participating practices of the WHCC division.
2. To achieve a 10% reduction in non-elective admissions that would release cost savings of around £35,000.

Joint Working Initiative with Teva UK Limited

In order to achieve these outcomes, WHCC worked in collaboration with Teva UK Limited as they provided:

• Project management and communication skills
• Experience of delivering health audits with the NHS
• A local Integrated Healthcare Manager and wider team to co-ordinate the initiative and bea source of contact for all stakeholders involved

Both the WHCC and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice.

Approach defined

Audit methodology

Baseline audit:

• Practices were sent a letter from WHCC informing them of the asthma project, inviting them to take part. Interested practices were then contacted by Teva UK Limited where an authorisation form was signed and agreement obtained for the audit to commence.
• Respiratory Nurse Specialists employed by NSHI Limited and sponsored by Teva UK Limited in line with the ABPI Code of Practice for the Pharmaceutical Industry 2012 carried out baseline audits. NSHI Ltd has undertaken audits successfully in other PCTs and all services are delivered in line with the Data Protection Act 1998 and related healthcare legislation. The NSHI nurses had no involvement
  in the educational or clinical mentorship aspect of the project.
• Data was extracted from the GP computer systems using MIQUEST. The quality of the audit was dependent on the quality and completeness of the practice clinical data.

12 month re-audit:

• Practices were re-contacted and signed authorisation was obtained to allow the Respiratory Nurse Specialists undertaking the re-audit, employed by NSHI Ltd to return to the practice to re-run searches and gather 12 month comparative data in line with project requirements and 14 practices were involved in the re-audit.
• Data was extracted from the GP computer systems using MIQUEST. The quality of the audit was dependent on the quality andcompleteness of the practice clinical data.

Practice Information

In WHCC, from the 14 practices included in the re-audit, the prevalence of asthma was 7.10% compared to 6.67% prevalence at the time of the original audit.

Outcomes achieved

(a) Reduction in hospital admissions and associated costs

• According to available hospital data reports there was a reduction of 48% in hospital admissions, in practices where re-audit took place, compared to a 28% reduction in practices that did not take part
• Again, utilising the available hospital data reports, this equated to a reduction in costs for hospital admissions in practices where re-audit took place of £59,137.68 (26%) exceeding the original objective

• In the majority of practices, READ coding of hospital admissions had improved

(b) Total costs for WHCC inpatient admissions for asthma

(c) Other patient outcomes observed

• 2% increase (125 patients) in patients attending an annual asthma review at re-audit
• 19% increase (732 patients) in patients who had an inhaler check performed at re-audit
• 35% reduction (150 patients) in patients with uncontrolled asthma, using >6 short acting bronchodilators in a 12 month period as a proxy measure of control

(d) Positive feedback from practice nurses

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy.

oint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care¹

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References

[1] Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008

Stockport Clinical Commissioning Group
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Improving respiratory outcomes in Stockport: Stockport Optimising Inhaler Technique (STOP-IT)

A Joint Working Case Study Stockport Clinical Commissioning Group (CCG) and Teva UK Limited

Download the joint working case study > 

This is a case study of how Stockport CCG participated in a local joint working initiative with the Project Group from Teva UK Limited to explore how cascading advanced knowledge of inhaler technique to healthcare professionals (HCPs) could help patients recognise their type of inhaler device and associated technique. 

Project rationale 

Research

Asthma and COPD are long term conditions that feature prominently in Domain 2 of the NHS Outcomes Framework 2013/2014 and National COPD and Asthma Outcomes Strategy, Department of Health. 

Research has shown that:

• Patient adherence to asthma can be improved, and the likelihood of treatment success increased, by paying attention to the factors that influence patients’ willingness to participate in their treatment.¹
  
• 7% of healthcare professionals can demonstrate all the recognised steps in administration, including assessment of inspiratory flow using the In-Check device.²
  

It has been demonstrated in several areas of the UK that engaging patients that use inhalers in Medicines Use Reviews and providing HCPs with the right skills and tools to deliver these can lead to an improvement in outcomes for patients.

Whilst prescribing might be optimal, if a patient cannot use their inhaler properly, there is a risk that their lack of control will result in further treatment interventions, such as unnecessarily high inhaled corticosteroid (ICS) doses. Patients with poor control of their asthma and COPD are more likely to have exacerbations and be admitted to hospital as a consequence.

The cost of medicines waste resulting from suboptimal inhaler use is considerable. Poor control may lead to extra cost with regard to GP and nurse appointments and hospital admissions.

For these reasons Stockport CCG identified inhaler technique as an area of focus in 2014 and 2015. A part of this focus stated a desire to leave a legacy of improved knowledge relating to Inhaler Technique across general practice in Stockport CCG and cascade this knowledge to patients via primary care healthcare professionals. 

Desired Outcomes

Recognising this opportunity, the objectives of this joint working initiative in Stockport CCG were to:

• Increase patients’ knowledge and confidence in managing their asthma and COPD
• Improve healthcare professionals’ knowledge and practical skills on inhaler technique

The joint working group was interested to see if and how this approach could reduce and prevent emergency hospital admissions amongst asthma and COPD patients.

Success Measures

The success of the project in meeting the desired outcomes was measured in the following ways:

• The use of patient questionnaires completed over the telephone with an accredited Advanced Inhaler Technique (AIT) enabled the trainer to highlight increased confidence in patients managing their asthma and COPD
• Improve HCPs’ knowledge and practical skills on inhaler technique – gather feedback from HCPs before and after attending the inhaler technique training

Joint Working Initiative with Teva UK Limited

In order to achieve these outcomes, Stockport CCG worked in collaboration with Teva UK Limited as they provided: 

• Project management and communication skills
• Experience of delivering AIT with National Health Service (NHS) colleagues
• Aerosol Inhalation Monitors and associated consumables (i.e. mouthpieces and placebo canisters) for use within GP Practices 

Both Stockport CCG and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice.³

Approach defined

The project was split into three distinct phases.

Outcomes achieved

The project succeeded in improving respiratory care by raising the importance of inhaler device technique in a consistent and informed way with healthcare professionals and patients.

Prior to the HCP inhaler technique training:

• 70% stated their confidence in instructing patients on inhaler device use was ‘average’
• 86% of respondents felt that their knowledge of the range of inhaler devices available was either ‘average’ or ‘poor’
• 59% felt that their knowledge of ‘inspiratory flow rate’ for the different available inhaler devices was ‘poor’

Positive feedback was received from healthcare professionals of the Advanced Inhaler Training

45 healthcare professionals were trained. After attending the HCP training on inhaler technique, the following percentage of healthcare professionals felt the following:

Patient demonstrated outcomes

11 patients reported back on the training. After receiving training from an HCP on inhaler technique as part of the project:

• 91% of patients were able to recall the difference between a Dry Powder Inhaler (DPI) and pressurised Metered-Dose Inhaler (pMDI) 
• 91% of patients were able to demonstrate the correct inhaler technique for their DPI or pMDI

The aim of recruiting more than 25 practices for the project was missed, with only 6 practices being recruited for reasons outside the scope of this project. However, those 6 practices were able to demonstrate patient outcomes.

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy.

The project improved respiratory care through improving the knowledge of healthcare professionals in relation to the types of inhaler devices available and the associated inhaler technique.

This improved the skills of the healthcare professionals so that they are able to support patients suffering with asthma.

Joint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care³

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References

[1] Van Ganse et al Factors affecting adherence to asthma treatment: patient and physician perspectives. Prim Care Resp J 2003;12(2):46-51
[2] Baverstock M, et al. Do Healthcare Professionals have sufficient knowledge of Inhaler Techniques in order to educate their patients effectively in their use? Thorax 2010;65:pA117[poster]
[3] Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008

Gloucestershire Clinical Commissioning Group
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Improving asthma outcomes in Gloucestershire via consistent Advanced Inhaler Training

A Joint Working case study between Gloucester Clinical Commissioning Group (CCG) and Teva UK Limited

Download the Teva & NHS Joint Working case study > 

This is a case study of how Gloucestershire CCG worked in a local joint working initiative with the Project Group from Teva UK Limited to improve asthma outcomes in relevant practices. 

Project rationale

Asthma and Chronic Obstructive Pulmonary Disease (COPD) are long term conditions that feature prominently in Domain 2 of the NHS Outcomes Framework 2013/2014 and National COPD and Asthma Outcomes Strategy, Department of Health.

Locally in 2011, NHS Gloucestershire - now Gloucestershire Clinical Commissioning Group (CCG) - saw an increase in number of hospital admissions per patient and number of patients admitted for asthma ICD-10 codes.

The CCG project lead approached Teva UK Limited to determine if they would be interested in working collaboratively on rolling out the Advance Inhaler Training module that had been recently accredited by the WCCPE at Cardiff University, as it focuses on the importance of inhaler technique which they believed was vital in order to gain control of the increase in admissions related to asthma.

Gloucestershire then had around 41,000 diagnosed patients with asthma and around 10,000 diagnosed with COPD, spending approximately £14m annually on respiratory care. However, it was recognised that:

• 50% of patients cannot use their inhalers correctly1
• 60% of patients with poor inhaler technique are more likely to have exacerbations2
• 91% of healthcare professionals who teach patients how to use inhalers could not demonstrate all the recognised steps involved in administering a Metered Dose Inhaler3

Gloucestershire CCG believed that having a number of accredited AIT trainers locally would have a positive effect on the integrated approach that they are aiming to achieve.

Through the formation of an asthma project group, there was a desire to run an AIT course to train 14 healthcare professionals (HCPs) from Gloucestershire CCG. These were made up of practice support pharmacists (PSPs) and practice nurses that had an interest in respiratory, along with secondary care respiratory pharmacists that had an interest in asthma.

Once the relevant HCPs had been trained and accredited via WCCPE, they were tasked with up-skilling other HCPs from the 86 practices, 113 community pharmacies and also the hospitals within Gloucestershire CCG.

The project aimed to improve respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients. 

Desired Outcomes

Recognising this opportunity, the objectives of this joint working initiative in Gloucestershire CCG was to:

• Ensure that the patients receive the highest level of asthma care within the primary care setting
• Ensure that patients will have a greater insight into their disease through education and an improvement in the use of inhalers through checking inhaler technique
• This will help address patient confidence and awareness of self-management plans, through education

Joint Working Initiative with Teva UK Limited

In order to achieve these outcomes, Gloucestershire CCG worked in collaboration with
Teva UK Limited as they provided:

• Project management skills
• Experience of delivering AIT with National Health Service (NHS) colleagues
• A local Integrated Healthcare Manager and wider team to co-ordinate the initiative and be a source of contact for all stakeholders involved

Both Gloucestershire CCG and Teva UK Limited abided by the relevant regulatory bodies and guidance, including the ABPI Code of Practice and guidance. 

Approach defined

The project was split into three distinct phases.

Outcomes achieved

The project succeeded in improving respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients.

(a) Over 900 healthcare professionals received Advanced Inhaler Training and consistent training around device technique

(b) Positive feedback was received from healthcare professionals of the Advanced Inhaler Training

Feedback was received from patients who participated

(c) Impact on hospital admissions and associated costs

Benefits of Joint Working with Teva UK Limited

This project demonstrated a successful collaborative approach to address a significant issue facing the local health economy. Factors beyond the scope of this project may have impacted on the project results achieved.

The project improved respiratory care by raising the importance of device technique in a consistent and informed way with healthcare professionals and patients.

Joint working between Teva UK Limited and the NHS must be for the benefit of patients or the NHS and preserve patient care.⁴

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References

[1] Restepo et al, Int of Chron Pulmon Dis 2008; 3(3): 371-384
[2] Garcia-Aymerich et al, Eur Respir J 2000; 16: 1037-1042
[3] Baverstock M, et al. Do Healthcare Professionals have sufficient knowledge of Inhaler Techniques in order to educate their patients effectively in their use? Thorax 2010;65:pA117[poster]
[4] Department of Health. Best practice guidance for joint working between the NHS and the pharmaceutical industry, 1 February 2008