Buvidal Administration by Community Pharmacists in Aberdeenshire

BUVIDAL ADMINISTRATION BY COMMUNITY PHARMACISTS FEASILIBILITY PILOT ABERDEENSHIRE

What is Buvidal? Form of opioid substitution treatment Contains buprenorphine Will produce the same effects as oral buprenorphine some differences from methadone First long acting buprenorphine injection licensed and available in the UK Lasts either 7 day or 28 days with a choice of strengths available Date of administration can be flexible to meet patients clinical need, optimise treatment and increase engagement Available for prescribing in NHS Grampian Offers choice in medication as per MAT standards

Potential benefits of Buvidal Will provide more stable plasma levels than daily medication Potential to reduces harms associated with missed and improve engagement Greater degree of independence for the patients Eliminate diversion of medication (and issues associate with this) Allows focus on other aspects of care at clinical appointments e.g. social and psychological factors

Potential Challenges Buprenorphine may not be the right treatment option for everyone Lack of daily contact with services such as pharmacy can increase isolation and reduce structure in a person s daily activity Logistics Large geographic areas such as Aberdeenshire rotate clinical staff across various locations and sites each week. Flexibility in dosing can be a challenge missed doses Additional task of administration for clinical teams Both increases workload pressures on clinical teams

So what have we done? Community pharmacy are experts in medication Many experienced in administration of injections through flu and Covid vaccination programmes Located in the patient s own community Relationships already exist between pharmacy teams and patients Pharmacies open every day access including on Saturdays Allows flexibility e.g. for patients working or in education More straightforward to rearrange missed doses always a pharmacist on site

So what have we done? Agreed to pilot community pharmacy administration of Buvidal Support from MIST team of national importance/interest as Aberdeenshire is first pilot to complete. Integrated teams continue to provide clinical, social and psychological support for teams Pharmacies undertake administration and feedback progress to teams

So what have we done? 5 pharmacies volunteered and met required criteria Peterhead, Banff, Inverurie and Banchory up and running Huntly still awaiting patients to get started staff report no suitable patients on caseloads Training providing including shadowing/observation of clinical teams Transfer of patients began Sept 2021 Currently 20 patients being administered naloxone in community pharmacies

Where are we at? Evaluation underway Clinical staff and Pharmacist interviews complete Patient interviews underway Patient interviews are being conducted by a volunteer with lived experience -another great step forward

Where are we at? Evaluation underway Clinical staff and Pharmacist interviews complete Patient interviews underway Patient interviews are being conducted by a volunteer with lived experience

Where are the results saying? Analysis not fully complete preliminary results Clinical staff Shire drug and alcohol teams

Clinical staff Main concern of clinical staff before starting was patients disengaging with other aspects of care / service appointments without the draw of a prescription however to date this has not been the case A few tweaks were suggested around paperwork and process but otherwise staff were satisfied with the process

Clinical staff Good working relationship with [the] pharmacy makes this process work really well. Improves patient options and choice. Spreads workload and allows more time to be devoted to other patients requiring higher levels of support and care "Convenient for patient. Benefits in time and workload of Mental Health Nurse and team" probably to early in the pilot to make any accurate positive or negative opinions"

Clinical staff "Patient Choice and flexibility. Fact that administration of medication, which is an involved process allows time with patient to discuss and focus on other aspects of wellbeing .. allowed quicker prescribing and reductions in waiting times, staff numbers allowing. Increases number of patients being supported appropriately and receiving the MAT that they request\require. Spreads and allows time to nursing staff and duties by freeing them on administration of Buvidal and allows time to other duties. over 90% is on a positive basis"

Patients Only 2 sets of results received to date interviews started this week

Patients

..more out of patients. More engagement and chat. More open. "Building relationships, Happy with service" Pharmacists All participating community pharmacists (10) agreed theirs was an appropriate and sustainable setting for this intervention All pharmacists who ADMINISTERED Buvidal (8) felt this intervention had improved their relationship with patients Better, open. See pharmacy in a more active role. Attended recovery meeting" In consultation room [with patient], feels different, more disclosure and open relationship .. More chat. Improved relationship - better.

Pharmacists Little change to process required by pharmacists Monthly per patient payment in line with existing OST patients acceptable to pharmacists puts NHSG in good stead for negotiating expansion with contractors using similar terms Training was identified as key to success Evening session Freeing up staff to shadow clinical teams/have clinical team shadow at pharmacy was key Initial set up costs required to facilitate this

QUESTIONS?