Jim Mc Ardle Principal Clinical Pharmacist

2. Who are Interface Clinical Services? Established in 2004 Clinical Services Provider to NHS Operate UK wide using clinical pharmacists with a wealth of experience Rigorous internal clinical governance procedures overseen by Interface Clinical Director Directly commissioned to deliver services for PCTs/PBC consortia/individual GP practices Deliver some pharmaceutical-industry sponsored work

3. Salford PCT Calcium and Vitamin D3 Deficiency Protocol Sponsored by ProStrakan Pharmaceuticals Role of sponsoring organisation is limited to liaising between GP practices and Interface Clinical Services to arrange date(s) of clinical review Project has full support of Salford PCT Medicines Management Team and Osteoporosis Clinical Management Team Project Aims - To identify those patients who at risk of calcium and vitamin D3 deficiency who may benefit from CaD3 supplementation - Support therapy intervention and patient education Protocol reflects both national (NICE/SIGN) and local guidelines (Salford PCT osteoporosis guidelines)

4. Salford PCT Calcium and Vitamin D3 Deficiency Protocol (continued) Patient criteria for review Patients with osteoporosis (read code N330) untreated Patients receiving bisphosphonates without Ca and D3 supplementation Patients receiving oral corticosteroids (>7.5mg prednisolone or equivalent for > than 3 months) Patients over 70 considered frail, increased risk of falls, or resident in care/nursing homes Patients over 75 with a Hx of low trauma fracture since age of 50 Patients on non-evidence based brands of Ca and D3

5. Salford PCT Calcium and Vitamin D3 Deficiency Protocol (continued) Exclusion criteria Hx of hypercalcaemia Primary hyperparathyroidism Severe renal failure Pagets Sarcoidosis Hx of renal stones Hx of CaD3 intolerance Drug-drug interactions Osteoporosis due to prolonged immobilisation

6. Summary of findings (2008) 2454 interventions across all 48 practices Average 51 interventions per practice Interventions include: Identification of compliance issues Initiation of medication (as authorised by GP) Patient referral to GP Identification of erroneous coding etc. to assist practice support teams Actual no. of interventions is dependent on: List size Patient population breakdown Work previously undertaken Accuracy of read-coding 48 practices undertook the clinical review 39 completed in one day 8 required 2 days 1 required 3 days

7. Lesson learnt from 2008 Audit Successes Efficiency Positive engagement across all practices Compliance with calcium and vitamin D3 products 314 patients across 48 practices Re-audit programme? Quality of data captured Issues? Solution? � �

8. Plan for 2009 PCT wide calcium and vitamin D3 clinical review programme Offered both to practices who undertook audit in 2008 and new practices who did not uptake the review programme in 2008 Improve the quality of data reported E.g 2008 audit revealed number of fractures in patients over 75. In 2009 we will look at prevalence data which will allow for practice benchmarking year on year Build on existing protocol through new inclusion criteria including: Patients receiving aromatase inhibitors for treatment of breast cancer Patients 50-74 with a history off a low trauma fracture Patients identified as non-compliant on bisphosphonates New Osteoporosis DES

9. Important Information To obtain the service please contact: Jennifer Richardson (ProStrakan Representative- 07989991517) Queries around protocol criteria etc: Contact Gaynor Loghan Specific queries regarding service delivery can answered by: Jim McArdle (jmcardle@interface-cs.co.uk/ Mobile 07894415170) More information about Interface Clinical Services please visit www.interface-cs.co.uk