The Community Pharmacy advising COPD patients about medical nutrition by Theresia Treschow-Kühl, Pharmaconomist, Master of Divinity & Master of Education and HR Aabenraa Løve Apotek, Aabenraa, Denmark Conclusion: Introduction: Weight loss: The weight loss was prevalent in the survey, was the expected In Denmark it is estimated 320.000 Danes have COPD, but only about 50 % result - but it was not! The information and knowledge about COPD should have been diagnosed. The Danish population is 5,6 million, it is a stagger- have given a result in the survey, that most of the costumers would have ing 7,5 % of the population suffer from COPD. In Denmark about 300.000 experiences a loss og weight. But loss og weight was not prevalent in the suffer from astma which is 7 % of the Danish population (The Danish Soci- survey - only 30 % of the costumers had lost weight, and 25 % had actu- ety of Lung disease). ally gained weight. In Denmark we have a strategy concerning Asthma Inhaling Instruction. The The factors can be many: Danish Board of Health awards the pharmacy a certain payment for every 1. A small survey - costumers are met at the counter, not costumers who Asthma Inhaling Instruction. are more or less housebound. The instructions of Astma Inhaling devizes are used by Astma and COPD 2. The costumers understanding when the loss of weight was an issue. patients, and the pharmacies have a certified advisory scheme concerning 3. Is it the “New normal” that counts when costumers who have been di- the use af Inhaling devizes. The Pharmacy already are in contact with the agnosed with COPD for more than 4 years 9 out of 14 either maintain costumers have established a dialogue with the patients. weight (7 persons) or even gain weight (2 persons). 4. Some especially women are content to loose weight, and do not con- Denmark do not have a strategy concerning COPD patients and nutrition, sider loss of weight as an issue - but a postive gain. and COPD patients are not systematically advised medical nutrition. Aabenraa Løve Pharmacy in Denmark made in January 2016 a small sur- The information level at the pharmacy: The level of information from the vey about medical nutrition and which patients gets medical nutrition. The pharmacy could have been better - survey 1. and 2. Only 15 % of the COPD survey had data collection of patients and their diagnosis. According to the costumers had advice from the pharmacy about nutrition and medical nutri- The initial survey - containing more information than showed here. The survey was made on the basis of selling Medical nutrition at Aabenraa Pharmacy The second survey was made on the basis of costumers buying COPD medicine - showed later tion. Considering 30 % of the costumers had experienced a loss of weight, survey the diagnosis was not disclosed inon the postermore in the questionnaire. than 50 % of the data, ei- ther because the patient was not in dialogueThe questionnaire is withbased on 20 answers. the pharmacist/pharma- it is not good enough. conomist or because the nutrition was givenProducts sold to costumersto withthird different illness. party on behalf of the COPD Operation Cancer Loss of appetite Unknown The factors can be many: patient. 1. The costumers might not understand it is medical advice, and consider The question arose if the pharmacy staff gave the proper advice about the 20 % 20 % it salestalk. medical nutritional products. 2. Costumers ignorance of the pharmacy and the advice and products we The survey showed more than 50 % of the costumers were not advised 15 % can provide. about the Themedical initial survey - containing more nutrition information than showed here. according to their diagnosis - even though the The survey was made on the basis of selling Medical nutrition at Aabenraa Pharmacy 30 % The second survey was made on the basis of costumers buying COPD medicine - showed later 3. The level of awareness about giving information. had personallyon the poster in the pickedquestionnaire. up the products. 15 % The questionnaire is based on 20 answers. 4. The understanding that the doctors do NOT give any advice about medi- Products sold to costumers with different illness. COPD patients with a prescription: cal nutrition even though they can prescribe medical prescription. COPD Operation Cancer Loss of appetite Unknown with presciption local GP Hospital 5. The pharmacy staff fear of advising the costumer on products that are not inexpensive. 20 % 20 % 25 % 6. The staff expect all COPD see a dietitian - when only 35 % had any in- 15 % formation from a dietitian. 30 % 75 % 15 % The future: In Denmark we have a strategy concerning Asthma Inhaling In- struction. The Danish Board of Health awards the pharmacy a certain pay- COPD patients with a prescription: ment for every Asthma Inhaling Instruction. The concern waswith presciption following, local GP Hospital did the pharmacy give correct advice to the patients, when the diagnosis was not known. At the same time we had focus Denmark do not have a strategy concerning COPD patients and nutrition, and on COPD and medical25 % nutrition, at it became even more evident we needed COPD patients are not systematically advised medical nutrition. In Denmark we to rethink our advice to the patients. already have two government paid medical advice services at the pharmacy - Aabenraa Pharmacy decided to make a second survey - more specifik about “The use inhaling devizes” and “New user - cronical disease”. We think it would COPD patients and their use75 % of medical Nutrition and dieterian advice. be with considering a third government medical advice service aimed at COPD patients and nutrition. The service should have the Danish Pharmaceutical As- sociations standards og QA, and the advice given should be under a programme with standards and surveys like the other government programmes. It could be combined with the service “New user - cronical disease”. That would ensure the costumers are not in any doubt when advised. In the survey 10 % did not Aims: know whether they had advice at the pharmacy. The programme should be a Aabenraa Løve Pharmacy had to ask ‚how can the pharmacy help COPD patients? continous programme - including weight control, advice on the use of COPD The pharmacist and Pharmacy Technicians need to know about medical nu- medicine, nutrition and medical nutrition when necessary. In Denmark 7,5 % trition AND they need to ask why the patient is prescribed - or buys without og the population suffer from COPD - there ought to be a huge potential for prescription - medical nutrition. They need to know about the special needs the pharmacy to play a central role in the treatment of COPD. COPD patients have, including weight issues. Facts: Methods: COPD Worldwide Becoming aware of our own practice: COPD is in illness that afflicts people worldwide. In 2012 5 % of all deaths 2. survey in June 2016 - who are our patients and do they need advice? in the world (3 million) due to COPD, 90 % of the deceased were in low income/middle income countries. WHO fear an increase of COPD by more Knowledge: than 30 % within the next 10 years estimated to be the third leading cause Teaching the staff initially about nutritional products - and the special needs of death in 2030. of COPD patients. The pharmacies in Denmark have a wide selection of nutritional products COPD has two main causes: from different providers. Many of the products can be prescribed (cheaper 1. Tobaccosmoking is prevalent in low-and middle income countries. for the patient). The Pharmacy can advise COPD patients to the right prod- Smoking from adolescence into adulthood shortens life about 10 years. ucts. The right medical nutrition can increase the intake of the vital proteins In the high income countries have many elderly, and increasing life- for building muscle tissue and an increase of calories leading to better qual- expectancy, many former smokers who still develop COPD, or have un- ity of life and decreasing the burden of hospitalization. diagnosed COPD. 2. Burning solid fuels indoor - heating and cooking - the use of wood, coal, Result: 2. survey peat, dung leftovers of straw etc. is a high risk area for women and children. COPD Patients and Medical nutrition Survey at Aabenraa Pharmacy 2016 Used at the pharmacy by the staff for over the counter costumers. The survey does not reflect the sales to nursing homes and costumers whose prescriptions have been sent to other shops or directly to the costumers. COPD patients have a short life expentancy: The surveys is a pilot - 20 questionnaires have been answered. How long have you'd had COPD Less than 1 year 1- 3 years More than 4 years (been diagnosed?) How is your appetite? Still got my appetite Have lost appetite - but still OK Difficulties in eating How is the weight? Still maintain weight Loosing weight Gaining weight Do you buy medical nutrition at the Yes (have presciption) No Buy WITHOUT presciption pharmacy? Have you had an any advice on Yes No Don’t remember/Don’t know nutrition including medical nutrition from the pharmacy? Have you had advice about nutrition Yes No Don’t remember/Don’t know from a dietitian? Have you had any dietitian advice Yes No Don’t remember/Don’t know from your local GP or from another doctor? The fysiological changes in COPD patients: 1. The metabolism is different due to a body in stress: COPD patient burns more calories than a healthy person often leading to underweight. Contrary to normal weight loss a COPD patient loose muscle tissue, not fat tissue causing poorer breathing and less muscles to chew food. The overweight COPD patient experience the fat tissue Results: becoming like a suit of armour that will not be burned off by normal Result of the survey exercise.