Profile of a Community Pharmacist

The ADAM Study has 50 Lloyds Pharmacies working as trial pharmacies across the country.  The pharmacists and their teams support the study by dispensing acamprosate in our trial bottles with MEMS Caps attached, and by keeping a record of the prescription each participant has, throughout their time on the Juliana Musa_Community Pharmaciststudy.  They are a vital part of the trial phase, seeing our participants on a monthly basis and therefore acting as a key point of contact.  All pharmacists and many of their team members have attended several training sessions so far to keep them up to date on the study procedures and requirements.

Juliana Musa is a pharmacist working at the Kimberworth Pharmacy in Rotherham, and she kindly agreed to a telephone interview with one of our researchers to help us understand how to become a pharmacist, and what the role entails.

Name: Juliana Musa               
Pharmacy: Kimberworth, Rotherham

 

Why did you decide to become a pharmacist?

My passion to become a pharmacist was driven by the desire to help patients and people. I have always been interested in pharmacy because, it is different from medicine which most people study back home. Understanding the various medications and how they would benefit patients is important; as I am motivated towards helping patients, and making their lives better.

 

Why a community pharmacist not industry or hospital?   

As a community pharmacist, you are in contact with the patient and this generates a certain closeness with them, thus producing positive results. With this close relationship established with the patient, they rely on you for medication or advice, which doesn’t happen in the same way in hospitals or the other arms of pharmacy.  It is all about being patient-centred for me.

 

What is your background, and how did you train to become a pharmacist?

I studied pharmacy in Nigeria, and graduated in 2000.  After practising as a community pharmacist in Nigeria, I came to the UK in 2007 and decided to take the conversion courses I needed to practise here.  I attended Robert Gordon University in Aberdeen, studying a one year programme with the final year pharmacy students, on completion; I did a pre-registration placement and exams which enable me to practise in the UK.  It has been an amazing transition for me, and a really good experience.

 

How long have you practised as a pharmacist?  Was that in community or hospital elsewhere?

I’ve been practising as a pharmacist for about 17 years.

 

How long have you worked for Lloyds?

This is my 6th year of working for Lloyds.

 

How long have you worked at the Kimberworth branch in Rotherham?

I’ve worked at the Kimberworth branch for 5 years. I did one year in a different Lloyds branch and before that and a few months at other branches, until I decided to come here. I’ve mainly worked for Lloyds but I have done a few hours working in other community pharmacies, to see their work pattern.

 

What is the best part of your job, and why?

The clinical aspect is the best part for me, as patients come in to enquire about particular medications and I have positive answers for them.  Also, when they come in for consultation about some kind of illness or ailment, and the medication I have recommended works for them and they come back to say “thank you pharmacist, this worked “.  Having consultations with patients is where I find my joy in practise so far.

 

What is the most challenging part of your job, and why?

For me the challenging bit is we do encounter language barriers from time to time. However facilities have been put in place by the company to assist this. We have also built good relationships with the community who help us with this

 

How have you found being involved in the ADAM study and the training you received?

I’m enthusiastic of the study and I’m definitely interested. I’m just working with the information you’ve provided us.  It is what helps us to get new services into the business, and if it is a trial that will benefit patients and the business, then, I am certainly open to it.  I am personally interested to see practical results.

 

What else could pharmacists and the pharmacy team do to support patients and families who are experiencing problems with alcohol now?

I believe counselling will go a long way towards addressing this problem. You need the family members to be present as well and to identify the root cause of the problem, duration of this patient current condition. Communication with patient is vital, as you can learn more, understanding patients to what may have triggered illness, so I feel we should talk and treat patients with respect.

 

 

How do you see the role of community pharmacists in the future, with regards to working with patients who may be experiencing problems with alcohol?     

Community pharmacists have a crucial role in the future as it will change and become more focused on patients; where pharmacists can become prescribing pharmacists, which has already started in some areas.  As a prescribing pharmacist, you can specialise in specific disease conditions or ailments.  Thus, you could have someone who specialises in alcohol treatment and runs clinics. I think it is the way forward for pharmacies, which is really good, because you are freeing up doctor’s time, and you have that good rapport with the patient and you can solve the problems immediately without needing the GP.

 

Do they have any research experience? Would you be interested to do more research in future, what sort of research and why?

I’ve never been fascinated by academics or research although if it is patient centred I am open to it.  I will welcome such an opportunity as long as it is patient centred.

 

 

Top 10 priorities for alcohol-related liver disease identified

dame-sally-davies“The number of people with alcohol related liver disease has been increasing over the last few decades: death rates have risen considerably in this time and alcohol is now one of the most common causes of death in the UK. So this is an important area for research. It’s vital that we bring together patients, carers and clinicians to decide jointly what the priorities for research are in this area, and the NIHR is pleased to support the James Lind Alliance in doing so.”

Professor Dame Sally C. Davies FRS FMedSci
Chief Medical Officer and Chief Scientific Adviser at the Department of Health

For the past two and a half years, I have been a steering group member for the first ever James Lind Alliance (JLA), Alcohol-Related Liver Disease Priority Setting Partnership – to identify priorities for research. Our group comprises of a diverse range of patients, carers, clinicians and researchers. I was involved in highlighting community pharmacy practice and research perspectives, to the group, based on my clinical and research experience. Recently we held a workshop in London, where the top 10 priorities for alcohol-related liver disease were identified. Below is a press release outlining our work and the top 10 priorities.

Dr Ranjita Dhital PhD, MRPharmS, Post-Doctoral Research Pharmacist for the ADAM study, IoPPN, King’s College London. Email: ranjita.dhital@kcl.ac.uk

PRESS RELEASE                                                     

NIHR and BSG launch top 10 research priorities for alcohol-related liver disease

‘What are the most effective ways to help people with alcohol-related liver disease stop drinking?’ is the top priority question for alcohol-related liver disease research, according to new results from the JLA’s Alcohol-Related Liver Disease Priority Setting Partnership (PSP).

Research into alcohol-related liver disease has been highlighted as a priority by the NIHR, which jointly funded the James Lind Alliance (JLA) PSP with the British Society of Gastroenterology (BSG). Alcohol-related liver disease has become the most common type of alcohol-related death in England. It accounted for 64% (4,441) of all alcohol-related deaths in 2011, and for 65% and 62% of male and female alcohol-related deaths respectively – most among those aged 50-59 years.

Simon Denegri, NIHR National Director for Patients and the Public in Research, said:
“The more we understand the priorities and concerns of people with alcohol-related liver disease, their carers and those health professionals treating them, the more we can ensure that the research that is funded is relevant to their needs. So I am delighted to see the results of the NIHR and BSG PSP have launched today. I hope it will be the basis for future research collaborations between patients, carers, health professionals and researchers leading to new ways to care for and treat people with this terrible disease.”

The PSP was set up through the JLA last year (2015). Data were collected through a survey asking patients, carers and health professionals for their unanswered questions around the diagnosis, treatment and care of alcohol-related liver disease. Over 230 responses were received from across the UK, and the top 25 questions were then taken to the JLA Alcohol-Related Liver Disease PSP workshop in September (2016), where health professionals, patients and carers worked collaboratively to reach the following final Top 10:

  1. What are the most effective ways to help people with alcohol-related liver disease stop drinking?
  2. What are the most effective ways of delivering healthcare education and information about excessive alcohol consumption, the warning signs and the risks of alcohol-related liver disease to different demographics (including young people)?
  3. What is the most effective model of community-based care for patients with alcohol-related liver disease?
  4. What is the patient’s experience of alcohol-related liver disease?
  5. Do attitudes to perceived ‘self-induced illness’ amongst healthcare professionals affect treatment, care provision and compassion for individuals with alcohol-related liver disease?
  6. What are the most effective strategies to reduce the risk of alcohol-related liver disease in heavy drinkers?
  7. Does the stigma associated with alcohol misuse affect the willingness of people with alcohol-related liver disease to ask for help?
  8. What interventions improve survival in individuals with complications of advanced alcohol-related cirrhosis?
  9. How should depression be managed in the context of alcohol-related liver disease?
  10. What models of involvement of palliative care services in advanced alcohol-related liver disease are most beneficial?

The full list of verified unanswered questions, is available on the alcohol-related liver disease PSP website: http://www.psp.nihr.ac.uk/alcohol-related-liver-disease/the-results

Dr Steve Ryder, Chair of the British Society of Gastroenterology (BSG) /British Association for the Study of the Liver (BASL) Research Development Group, said:
“Alcohol-related liver disease (ARLD) is a disorder that has had disproportionately little research attention or spending in the past, despite its impact on patients and their families. ARLD remains the second highest cause of years of life lost in young men.  It is a huge step forward that the NIHR with BSG have been able to help set a series of key research questions which cover all aspects of ARLD, from its stigma to the potential areas for new treatments.  BSG believes that this provides a key step in ensuring that people and carers of people with ARLD will gain access to better understanding of the disorder and better treatments in the near future. We look forward to calls for research to answer these questions.”

Dawn Pallant, a patient involved in the Alcohol-related liver disease PSP workshop, said: “It was a real privilege to be involved in this day organised by the JLA. It is extremely unusual and an extraordinary opportunity for all of these people (patients, doctors, medical specialists, carers, charities and potential funding bodies) to have the time to meet with the prime objective of setting priorities to fund research. “

The Top 10 priorities encourage new research into alcohol-related liver disease and guide researchers to answer the questions that are important to those affected by the disease. To find out more about the work of this JLA PSP, please visit
www.psp.nihr.ac.uk/alcohol-related-liver-disease.

For more information please contact:
Kelly Lockhart – Communications
National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre
Tel: 023 80595775 Email: k.lockhart@southampton.ac.uk

Notes to editors
JLA: The James Lind Alliance Priority Setting Partnership (JLA PSP) infrastructure is hosted by the National Institute for Health Research (NIHR) to provide the support and processes for Priority Setting Partnerships (PSPs). PSPs aim to help patients, carers and clinicians work together to agree which are the most important treatment uncertainties affecting their particular interest, in order to influence the prioritisation of future research in that area. For further information, visit the JLA website (www.jla.nihr.ac.uk).

NIHR: The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).

BSG: The British Society of Gastroenterology (BSG; www.bsg.org.uk) is a registered charity and the professional organisation for the promotion of gastroenterology and hepatology within the United Kingdom. We have over 3,000 members, drawn from the ranks of physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in the field. Founded in 1937, the BSG has grown from a club to a major force in British medicine and a renowned name at European and broader international levels.

UK Alcohol Policy: an overview

If you are familiar with the ADAM trial you will know we are investigating whether additional support – in the forms of medication management delivered by pharmacists and contingency management – improves adherence to acamprosate medication that is prescribed for people with a diagnosis of alcohol dependence. Treatment for alcohol problems is an important part of recovery and Public Health England reports that around 115,000 adults access alcohol treatment services each year.

However when we look at statistics on alcohol treatment, we are only seeing part of the story. Alcohol Concern report that only 1% of the estimated 1.5 million dependent drinkers in the UK actually access treatment. The British Liver Trust states that liver disease is the only cause of death that is rising year on year. One way that the harms from alcohol can be tackled in a broader sense is through health policy designed to reduce alcohol consumption and related harms.

gov-image-1

1 image from https://www.gov.uk/government/publications/health-matters-harmful-drinking-and-alcohol-dependence/health-matters-harmful-drinking-and-alcohol-dependence

So what kinds of policies do we have already?

There is a long-standing and complex system of taxation and duty on alcohol, including a more recent ban on below-cost alcohol sales in England and Wales, as well as restrictions on alcohol advertising.

The most recent alcohol policy document was the 2012 UK Government’s Alcohol Strategy. The main priority areas here were pricing, giving power to local agencies, working with industry, and health information. However, this was a policy of the previous coalition government and there has not been an updated strategy following the Conservative administration which began in 2015.

The most high profile proposed policy has been setting a minimum price for alcohol. If prices increase, then alcohol consumption and alcohol harms should fall. In other countries (such as Canada), minimum pricing has been shown to reduce harm from alcohol and save lives.

How much will it cost?

  Available currently at…* Under a minimum price of 50p a unit…
Can of lager

(440ml at 4.8% ABV)

£0.71 £1.06

 

Bottle of white wine

(750ml at 12% ABV)

£3.30 £4.50

 

Bottle of vodka

(700ml at 37.5% ABV)

£10.00 £13.15
Large bottle of strong cider

(3l at 7.5% ABV)

£3.50 £11.25

*using Tesco.com and Iceland.co.uk prices 2nd November 2016

This minimum price is unlikely to have an impact on the prices of drinks in pubs, but will mean that drinks in the shops become more expensive.

In Scotland, legislation to implement minimum unit pricing for alcohol was passed back in 2012, but this legislation has been followed by years of legal challenges led by the Scotch Whisky Association. It was recently  announced that this policy does not violate any EU law, but again this has been followed by the Scotch Whisky Association’s decision to appeal to the UK’s Supreme Court. This protracted legal challenge by the Scotch Whisky Association is a perfect example of the tensions that exist between public health and big business. Scotland is the UK nation where alcohol minimum pricing has gained the most traction, and despite the repeated industry challenges, still has the potential to lay foundations for the rest of the UK. 

An interview with a service user: Ann’s recovery story

Name:                         Ann Taylor

Age:                            47

Marital Status:           Separated

Children:                     Two grown up children; Sam is 20 and lives with his father, and Georgia is 25 and lives with her partner and child.

Housing Status:          Private tenant, lives alone

Occupation:                Unemployed, has previously worked as a hairdresser

 

Background:              

I’d always been someone who enjoys a drink, and my husband and I met in the pub in our local area.  When my children were young I didn’t drink much at all because I had to be responsible for them.  Once they got a bit older (at secondary school), I started drinking more again.  It started out with just a glass of wine on an evening, but soon I was drinking one or two bottles of wine a night.  My husband and I were arguing a lot around this time, and the alcohol was a bit of an escape for me.  We ended up arguing lots about the alcohol too, as he hated me drinking and getting into a state.  It started to affect other things in my life and I ended up losing my job through alcohol because I kept phoning in sick, especially on weekends and on Mondays because I’d usually drink more on those days.  My husband and I eventually split up five years ago and I moved into a rented place by myself. My son was 15 at the time and he said he’d rather stay with his dad than come live with me.

 

Experience of alcohol treatment:

The main thing that made me get help for my alcohol was when my first grandchild was born last year.  My daughter said I wouldn’t be allowed to look after Ruby by myself unless I stopped drinking and proved that it was for good this time.  I’d tried by myself before but I knew this time I needed help.  I went to my GP, who referred me to the alcohol team.  I went for my detox in an inpatient unit earlier this year, it was really hard and I was in there for two weeks.  They started me on Campral while I was there and I’ve been taking it ever since.  I’m not sure if it helps, I haven’t really had any cravings so I think it must be making a difference.  I sometimes struggle to take all six tablets every day, and sometimes I miss the lunchtime tablets because I forget to take them out with me.

 

Plans for the future:

I’m going to SMART Recovery groups and AA meetings to help me keep on track.  My relationship with my kids is already better than it was, they say they prefer me like this.  For the future I want to stay abstinent and be able to be around my granddaughter to help my daughter out.

girl

 

 

Details is this article have been based on a fictional service user to keep the identity of individuals confidential  

 

ADAM Newsletter-September 2016

Autumn Newsletter  

ADAM Trial Pilot

With the change in season marks the beginning of the end of the pilot phase of the ADAM trial. Recruitment has offcially begun across the five study sites, with all sites successfully recruiting their first participant. Thank you to all the clinical teams for their referrals and ongoing support.

Recruitment update

We are pleased to report we currently have thirty-one participants recruited across all five sites and have begun to complete the first two-month follow-ups.

Our Birmingham site is steaming ahead with eleven participants successfully recruited. Researchers from all sites have been working hard with clinical teams to identify suitable participants. We will continue to work to reach our target of eleven participants per site per month.

The recruitment push will continue as we look to complete the pilot phase this autumn. Thank you for all the referrals so far and to all participants who have signed up!

A warm welcome to Maria-Leoni Koutsou!

She is the new research assistant based in Birmingham.

 

Delivering relapse prevention medication training to primary care

Following the identification of training needs in primary care services by Central North West London (CNWL) alcohol services, the research team  organised a training session, ‘Alcohol Dependence and Relapse Prevention Medication in Primary Care’ to provide an opportunity to build links between primary and secondary care services.

This training and networking event had over thirty GPs, practice nurses, pharmacists, consultant psychiatrists and recovery workers from across the eight boroughs in CNWL come together. The training session was delivered by Professor Anne Lingford-Hughes from Imperial College London. She shared her breadth of clinical experience and academic knowledge with the room. The session raised awareness of alcohol related harm and developed skills and knowledge to manage alcohol related problems in primary care.

The ADAM team are committed to building links between primary and secondary care to improve patient care and treatment pathways. The feedback from the event has been overwhelming positive. Special thanks to Ealing CCG and Alcohol Research UK for their support in organizing this event.

cnwl-training-event

 

Who is your local research assistant?

Maria-Leoni Koutsou, Birmingham Research Assistant, Maria-Leoni.Koutsou@bsmhft.nhs.uk

Kate Shirvell, Southampton Research Assistant, K.Shirvell@soton.ac.uk

Rachel Simpson, Yorkshire and Humber Research Assistant, Rachel.simpson9@nhs.net

Kideshini Widyaratna, South London and Maudsley and Central North West London Researcher, Kideshini.widyaratna@kcl.ac.uk

Contingency management in addiction research

What is Contingency management?

Contingency management is a treatment strategy that aims to increase motivation and encourage positive behaviours. It’s based on the simple behavioural principle that if a behaviour is rewarded it is more likely to be repeated. In psychology this is known as operant conditioning.  This principle is used in everyday life.

Examples of contingency management in everyday life:

  • Parents use pocket money (incentive) to encourage children to tidy their bedrooms (positive behaviour)
  • Employers use salaries and bonuses (incentive) to reward high performance and hitting targets (positive behaviour)

 

Contingency management as an intervention in addiction treatment

In addiction treatment contingency management can be used to encourage and reward behaviours that are consistent with a drug free lifestyle. Rewards are often in the form of vouchers or gift cards that can be exchanged for goods and services that are also compatible with a drug free way of life.

 

Contingency management as an intervention in addiction treatment

Examples of contingency management in addictions treatment:

  • Service users are rewarded for providing urine specimens that test negative for drugs, encouraging abstinence.
  • Service users are rewarded for attending clinic appointments, encouraging engagement with treatment

 

Contingency management in addiction treatment – is it controversial?

There is a controversy surrounding the use of contingency management in addictions services. One of the main concerns is that the financial incentives given to service users could be used to buy drugs. Another concern is that by encouraging behaviour change with external rewards the participants’ internal motivation could be reduced, which could lead to problems with motivation in the long term. Contingency management has also been criticised because it not only costs a lot with regards to the incentives given but also with regards to the amount of time it takes for it to be administered. However there is scientific evidence to suggest that contingency management is worth the investment.

Contingency management and addictions research – The ADAM trial

Research studies have previously demonstrated that incentive-based treatments are successful in motivating people to remain abstinent from drugs and remain in treatment. These research studies have been carried out with a variety of drugs including stimulants, opioids, marijuana, nicotine and alcohol.

RD CM

One aim of the ADAM Trial is to find out whether contingency management is successful at encouraging participants to engage with the telephone support provided by the pharmacist. Participants who are randomised to receive both the telephone support and the incentive, which is called the personal achievement award, will be rewarded with a £5 Love2Shop voucher for each of the 12 telephone call they complete over the 6 months of the study. In addition to this participants will be rewarded with a bonus each time they complete four calls in a row. A total of £120 can be earned for completing all support sessions and these vouchers can be spent in a range of places including high street stores, supermarkets (excluding cigarettes and alcohol) and on days out.

 

Personal achievement award

Sessions completed Incentive Bonus Running total
1 £5 £5
2 £5 £10
3 £5 £15
4 £5 £10 £30
5 £5 £35
6 £5 £40
7 £5 £45
8 £5 £20 £70
9 £5 £75
10 £5 £80
11 £5 £85
12 £5 £30 £120
Total £60 £60 £120

 

By carrying out this research we are able to learn about how effective the personal achievement award is at increasing engagement with telephone based support for alcohol dependence.

If you are taking part in the ADAM Trial and would like more information about where you can spend your Love2Shop vouchers, please click here https://www.highstreetvouchers.com/gift/where-to-spend-love2shop-cards

References

Cameron, J., & Ritter, A. (2007). Contingency management: perspectives of Australian service providers. Drug Alcohol Review, 26(2), 183-189.

National institute on drug abuse (2012). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine. Retrieved 18 August, 2016, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/evidence-based-approaches-to-drug-addiction-treatment/behavioral-0

Petry, N. M. (2002). Contingency management in addiction treatment. Retrieved 18 August, 2016, from http://www.psychiatrictimes.com/addiction/contingency-management-addiction-treatment-0/page/0/1

Petry, N. M. (2010). Contingency management treatments: Controversies and challenges. Addiction, 105(9), 1507-1509

Petry, N. M. (2000) A comprehensive guide to the application of contingency management procedures in clinical settings. Drug Alcohol Dependence, 58(1-2), 9-25

ADAM Newsletter- August 2016

Summer Newsletter 

Trial Launch Date 19 July 2016

We are thrilled to announce the launch of the ADAM Study, recruitment has begun across the five study sites, and we look forward to updating you with progress in the Autumn newsletter.  Thanks to everyone involved with getting to this point, we appreciate the support from you all.  Thanks also to the clinical teams for their patience while we wait to launch the study.

Congratulations to the ADAM Trial Manager Dr Kim Donoghue on the birth of her baby boy in early June

We’d like to give a warm welcome to Dr Sadie Boniface who is in post to cover Kim’s maternity leave – welcome to the team Sadie!

Building links with CNWL addiction specialist services

To continue the further development of our telephone intervention pharmacists we conducted  a training and networking event  with the Central and North West London (CNWL) Addiction Specialist Pharmacists. This session helped build links and relationships between our trial pharmacists and addiction specialist pharmacists. This meeting provided a unique learning opportunity for the telephone pharmacists to gain insight and understanding of the range of support given by pharmacists in drug and alcohol service. Many thanks to Fahreen Hasham, Noor Assadi and Soyar Sherkat who shared their time and wisdom with us.

Training and development 

Visit the link below for the latest available MOOCs:

https://www.futurelearn.com/courses/upcoming

Information on Good Clinical Practice Training is available here:

https://www.crn.nihr.ac.uk/learning-development/good-clinical-practice/

NIHR New Media Competition

The ADAM team entered the NIHR New Media Competition, and created a 2 minute video about the study and Patient and Public Involvement in developing the trial.  Unfortunately we were not successful in being shortlisted, but you can read the story of creating the video in the ADAM Study Blog.

You can view the video here: https://youtu.be/XH1_Tc7lMug

Special congratulations to Professor Sir John Strang who received a Knighthood in the Queen’s birthday honors this year for services to medicine, addiction and public health.

Professor Strang is Head of the Addictions Department in the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) and is also Leader of the Addictions Clinical Academic Group of King’s Health Partners Academic Health Science Centre.

 

Wishing everyone a lovely Summer!