Making the Flu Vaccination service work in your pharmacy Martin Littleton – Implementation Manager Supporting Community Pharmacy across Avon
Outcomes of the Evening • Why has the service been commissioned? • Outcomes from 2014 • What the service looks like across BNSSG • How to run the service • Self Accreditation – Declaration of Competence • PharmOutcomes • How to maximise uptake of the service – Staff Engagement – How to target the correct patients • Your commitment Supporting Community Pharmacy across Avon
Why Provide a Community Pharmacy NHS Influenza (‘Flu) Service? • Vaccinating people against ‘flu can prevent ill -health and possible death from ‘flu over the winter and reduce hospital admissions • This is true for the whole population, but especially important for the clinical at-risk groups • Primary care is not achieving high enough vaccination rates for clinical at-risk groups Supporting Community Pharmacy across Avon
The National Picture – ‘Flu vaccine uptake rates 2013/14 – 2014/15 Source: Public Health England: ImmForm reporting website: Data submitted by NHS trusts and area teams. Supporting Community Pharmacy across Avon
The South West Picture Uptake rates 2013-14 vs 2014/15 Seasonal flu vaccine uptake in the over 65s across South West CCGs 100 90 80 70 % Uptake 60 50 40 30 2014/15 20 2013/14 10 0 South South North NEW Bristol Somerset Somerset Glouceste Cornwall Devon & England Devon rshire Torbay 2014/15 75.2 76.3 71.3 78.0 70.4 71.6 68.2 72.8 2013/14 75.7 77.1 72.5 79.4 71.3 72.2 69.1 73.2 Target 75 75 75 75 75 75 75 75 75 Supporting Community Pharmacy across Avon
The South West Picture Uptake rates 2013-14 vs 2014/15 Seasonal flu vaccine uptake in the under 65s at clinical risk across South West CCGs 100 90 80 70 % Uptake 60 50 40 2014/15 30 2013/14 20 10 0 North South South Somerse NEW Bristol Somerse Gloucest Cornwall Devon & England t Devon t ershire Torbay 2014/15 51.3 52.7 48.2 56.9 49.4 45.9 45.0 50.3 2013/14 51.1 54.2 51.3 59.6 52.5 49.2 47.6 52.3 Supporting Community Pharmacy across Avon
How can a Pharmacy Service Make a Difference? • Increases the overall vaccination rates, especially in harder to reach groups through: • Better accessibility • Many convenient locations • Long opening hours – open when the patient needs us • Great patient satisfaction • We are already vaccinating people who are eligible for a free NHS flu Jab (via the private service) • ‘At - risk’ groups could attend a pharmacy up to five times within the ‘flu season for a prescription presenting opportunities for vaccination Supporting Community Pharmacy across Avon
Service Performance 2014 • 3,643 vaccination delivered through 162 pharmacies Pharmacies� Pharmacies� Number� of� Average� /� accredited Vaccinated vaccines� Pcy delivered N� Som 23 23 � � � � � � � � � � � � � � � � � � � 392 17.0 S� Glos 28 28 � � � � � � � � � � � � � � � � � � � 660 23.6 Bristol 53 52 � � � � � � � � � � � � � � � � 1,477 27.9 Somerset 61 59 � � � � � � � � � � � � � � � � 1,114 18.3 Total 165 162 � � � � � � � � � � � � � � � � 3,643 22.1 Supporting Community Pharmacy across Avon
Service Performance 2014 Main� Carer� Risk� category?� Chronic� Respiratory� Disease� Diabetes� 4%� 1%� 1%� 2%� Chronic� Liver� Disease� 8%� 9%� Chronic� Heart� Disease� 8%� 1%� Pregnant� Woman� 46%� 20%� Immunosuppressed� Chronic� Renal� Disease� Neurological� condi on� Asplenia� or� dysfunc on� of� the� spleen� Supporting Community Pharmacy across Avon
Service Performance 2014 Was� the� pa ent� vaccinated� in� 2013?� Has� the� pa ent� ever� been� vaccinated� 41%� Yes� for� flu?� No� 59%� 21%� Yes� No� 79%� Supporting Community Pharmacy across Avon
Service Performance 2014 For� pa ents� vaccinated� in� 2014,� were� they� vaccinated� on� 2013?� 1800� 1600� 1400� 1200� 1000� Yes� 800� No� 600� 400� 200� 0� Oct-14� Nov-14� Dec-14� Jan-15� Feb-15� Mar-15� Supporting Community Pharmacy across Avon
Service Performance 2014 More� convenient� Why� choose� pharmacy?� No� GP� Clinic� dates� available� 0%� 1%� 1%� 0%� GP� unable� to� provide� service� 12%� Unable� to� a end� GP� -� work� 5%� commitment� Unable� to� a end� GP� -� other� 13%� commitments� 62%� Prefer� Pharmacy� Unable� to� a end� GP� -� transport� problems� 3%� 3%� Other:� Unwilling� to� say� Unable� to� a end� GP� -� previous� experience� Supporting Community Pharmacy across Avon
What has been Commissioned? • Inclusion criteria for the service • The service will commence in September 2015 and terminate on 31 st March 2016 • Must have consented to vaccination • People aged 65 years or over (including those who will turn 65 by 31 st March 2016) • Patients aged 18 to 64, who must be from one of the following clinical risk groups:- Supporting Community Pharmacy across Avon
Respiratory Disease • Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission • Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; • bronchiectasis • cystic fibrosis, • interstitial lung fibrosis • pneumoconiosis • bronchopulmonary dysplasia (BPD) Supporting Community Pharmacy across Avon
What to look out for: • Anyone with a steroid inhaler • Anticholiergics (tiotropium , ipratropium…) • long acting B 2 agonist • Montelukast • Theophylline • Nebules • Steroids (for breathing.) • For cystic fibrois … Creon capsules ursodeoxycholic acid, antibiotic nebulisers? • Not just Ventolin!!! Supporting Community Pharmacy across Avon
Chronic Heart Disease • Congenital heart disease • Hypertension with cardiac complications • Chronic heart failure • Individuals requiring regular medication and/or follow-up for ischaemic heart disease Supporting Community Pharmacy across Avon
What to look out for: • Congenital Heart disease - Patients with stents, replaced valves, ‘hole in the heart’ – not generally medically treated • Chronic heart failure • Symptoms include dyspnoea, especially during and after exertion (but even at rest if severe), wheeze, cold extremities to name but a few • Treated with combinations of loop diuretics, ACE- inhibitors, β -blocker, spironolactone, digoxin Supporting Community Pharmacy across Avon
What to look out for: • Ischaemic heart disease • AKA coronary heart disease, coronary artery disease • angina medication i.e. regular GTN, nitrates, β -blockers, calcium channel blockers etc. • Complications of hypertension – retinopathy, haemorrhage, kidney problems Supporting Community Pharmacy across Avon
Chronic Kidney Disease • Chronic kidney disease at stage 3, 4 or 5 • Chronic kidney failure • Nephrotic syndrome • Kidney transplantation Supporting Community Pharmacy across Avon
What to look out for: • Drugs including: • Vitamin D analogues including alfacalcidol • Phosphate binders (eg. Calcium, lanthanum, sevelamer, aluminium hydroxide) • High doses of loop diuretics • Immunosuppressants (e.g. ciclosporin, tacrolimus, azathioprine, mycophenolate) • ACE-inhibitors or angiotensin II receptor antagonists are used in nephrotic syndrome to address proteinuria as well as furosemide/spironolactone Supporting Community Pharmacy across Avon
Chronic Liver Disease • Cirrhosis • Biliary atresia • Chronic hepatitis Supporting Community Pharmacy across Avon
What to Look Out For: • Drugs including:- • Colestyramine • High dose ursodeoxycholic acid • Penacillamine • Spironolactone • Loop diuretics • Vitamins i.e. vitamin B, pyridoxine, fat soluble vitamins (A,D,E,K) • Disulfram, acamproste, chlordiazepoxide? • Substance misuse patients? Supporting Community Pharmacy across Avon
Chronic Neurological Disease • Stroke • Transient ischaemic attack (TIA) Supporting Community Pharmacy across Avon
What to Look out For: • Aspirin • Clopidogrel • Dipyridamole • NOT warfarin!!! Supporting Community Pharmacy across Avon
Diabetes • Type 1 diabetes • Type 2 diabetes requiring insulin or oral hypoglycaemic drugs • Diet controlled diabetes Supporting Community Pharmacy across Avon
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