I met Mr Laird at the Commissioning Show this year. It was a nice pleasure to meet a pharmacist who has pushed some of the boundaries in asthma management. I say ‘some’, because Mr Laird has the potential to push more – to step up – to optimise more than medicines. Who am I to comment? The more that I have done, the more I see what I miss and understand the need to look differently.
I lead the medicines optimisation function for the NHS Alliance and, in my view, medicines optimisation is not medicine focussed, but patient focussed. It is never about achieving what we want to achieve – it is all about helping people to reach their goals. We might say that it is about improving outcomes – but which outcome – and do they matter to our patients? It is fundamental that pharmacists take a problem solving approach and know how to SOAP patients.
It asks the following questions:
- What is the problem
- How can medicines help to solve that problem
- What else is needed for success
So just to be clear – inhaler technique is not the problem – but improving inhaler technique may be an element of the solution.
My first experience here was asking the usual questions about asthma control. “Do you get breathless or start to cough when you run for a bus”. The answer of “No” was a surprise and I looked up and straight into the face of a young woman who had just the glint of a tear in her eye. “I never run for a bus – I am too frightened to get breathless – I am so unfit”. So for many years this young woman avoided any form of exercise. She had played a little hockey and netball at school (all team games) and the people at her work have been asking her to join their team. A different plan was required with a different focus on medicines. She was never going to be another Paula Radcliffe (who also has asthma), but she wanted to take part. Then I spotted all of the other similar patients I had missed!
So the real problem here was getting her fitter and more confident to take part in team sports.
My second experience was looking at the number of children who missed school or performed badly. I was surprised by the numbers and the potential impact on life chances – how three weeks of absences each year catch up over 14 years. It is just not cool for a 5 year old to have asthma and it just gets worse right into adolescence. So some children just do not want to get their inhaler out or be taken into the office for a puff or two. Their friends do not understand so compliance with therapy drops off.
So here is the second problem – how do you make asthma and asthma treatment ‘cool for kids’?
And my final experience is being asked about asthma related deaths. There was an unexpected asthma death. Of course she was 20, died in her bedroom and was found by her parents, making the case horrific. She was competent with inhaler technique, had an excellent asthma plan and everything seemed to be in place. Actually we all know of people who have died from asthma – Scarlet (Charlotte Coleman) from 4 weddings and a funeral and Stuart Baggs from the Apprentice. So why does it happen? Do they really believe they are immortal and they have time before they get help and implement their rescue plan?
So the final problem is what can we do to reduce the chance of asthma death?
In my past I have considered all of these problems. Exercise programs for asthmatic patients – bling up your inhaler – and asthmatics aren’t immortal all spring to mind.
But I don’t work in this field any more – I am a commentator – it’s over to you Johnathan