16 CHEMIST+DRUGGIST 16.01.2016

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Being diagnosed with a chronic condition can leave patients scared and worried about the future

Module 1776Newly diagnosed chronic conditionsFrom this module you will learn:

● The impact of a chronic condition diagnosis on a patient and their loved ones ● The role of the pharmacist in supporting these patients ● The benefit of pharmacy services when supporting these patients ● How good listening and communication skills are essential

Philip CrillyPharmacy teaching fellow, Kingston University

Chronic conditions are long-term diseases that cannot be cured at present, but are often managed with medication and/or lifestyle interventions. The most common chronic conditions in the UK a�ect about 15 million people and include heart disease, diabetes, arthritis, HIV, dementia and multiple sclerosis.

Diagnosis with a chronic condition can have a huge impact, not only on the patient, but also on their loved ones. As pharmacists, we are in a unique position to support the patient and help them live as normal a life as possible, taking into consideration their own priorities and how they would like to self-manage their condition.

A new diagnosisThe stages of being diagnosed with a chronic condition vary from patient to patient. Some will self-diagnose after checking their symptoms online via a search engine or social media network. A study found that of those patients who used the internet to self-diagnose, 33% did not visit a healthcare provider to get a professional opinion, 41% did visit a healthcare professional and had their self-diagnosis confirmed, and 18% visited a healthcare professional, who did not agree with the online diagnosis.

Many patients will have no symptoms at all, but might go for an NHS health check or a health risk assessment at a pharmacy. Based on the results of these tests, they might discover that they are potentially living with a chronic condition. A signposted visit to their GP can often confirm the diagnosis. As conditions such as hypertension and hypercholesterolemia are often asymptomatic, it can come as a complete shock to patients that they have been living with a chronic disease without being aware of it.

For other patients, a medical emergency such as a heart attack might be the point when they discover that an undiagnosed medical condition has led to a serious health problem.

The impact on patients and their familiesA new diagnosis of a chronic condition can leave patients feeling scared and alone. It may be the first time they have heard of the disease they have been diagnosed with, so a sense

of the unknown and an uncertainty of what the future holds will be at the forefront of their mind.

Patients may feel that their future will not be what they had envisaged. They worry that they might not be able to do the things they

January

● Parasites in cats and dogs January 9*

● Newly diagnosed chronic conditions January 16

● Tiredness and Chronic fatigue syndrome January 23

Practice: ● How to market your pharmacy January 30

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Being diagnosed with a chronic condition can leave patients scared and worried about the future

had hoped to do and fear they may have a lower quality of life as a result. These feelings can be amplified in patients who have multiple chronic health problems. An increase in the number of chronic conditions a patient is being treated for can have an impact on their sense of wellbeing.

A chronic health problem can mean a patient is unable to work or contribute to society, therefore becoming dependent on others. This can massively a�ect a person’s feeling of self-worth and is something that will need to be addressed. Some pharmacists may feel that this level of support is outside their comfort zone. In this instance, it is necessary to know who to signpost these patients to for further guidance and treatment.

The link between chronic health conditions and depression is unclear. Some studies suggest that the presence of depression can make someone more likely to develop a chronic health condition; other studies indicate that the presence of a chronic condition can precipitate depressive symptoms. While it is not definitive, it is clear that there is a link.

There is a great risk that, if not treated, depression can become a chronic condition on its own, further adding to a patient’s health burden. As a result, patients may be unable to adhere to medication regimes or look after themselves properly. Supporting patients who have a chronic health condition with their mental health is, therefore, a huge priority. It is important to be able to recognise these symptoms and know when to refer patients to their GP.

The role of the pharmacistFrom a prevention perspective, pharmacists can deliver a number of di�erent health risk assessments that can help patients to identify early if they are more likely to su�er from a certain chronic condition. The patient, with our support, can then take some preventative measures to reduce their risk of developing this condition. Examples include diabetes risk assessments and NHS health checks.

As experts in the management and treatment of chronic conditions, we often want to share everything we know about the illness with the patient. This, of course, may not be what the patient wants to know, so we need to be very conscious about putting the patient first and letting them make the most appropriate choice for themselves in terms of disease management. When initially diagnosed with a chronic condition, a patient might be overwhelmed with the diagnosis itself, so will need some time to think through the questions they would like answered. Give the patient time, letting them know that you are available if they want to discuss any of their concerns.

Our role is to reassure the patient that the future is not bleak. We should discuss

the treatment options available, signpost to appropriate support groups or online discussion forums and provide a listening ear during times of worry or concern.

It is important to put ourselves into the shoes of the patient and to understand what they would expect from their pharmacist. They will see us as someone who can give them advice on their new medicines – what they are for, how to take or use them, what side e�ects to expect and how they should deal with these side e�ects. In addition, the patient will probably have questions about how to tell if the treatment is working and how they can tailor their lifestyle to be in the best health they can with this new disease. The more knowledge and information a patient has about their condition and its treatment, the more empowered they will become. This will enable them to take back control of their health and life, which will get them back on the road to feeling positive about the future.

Supporting patients with di�ering chronic health conditions can highlight some gaps in our own knowledge about the treatment

of these diseases. It is important that we keep abreast of new clinical guidelines and use opportunities to learn more to support our CPD requirements. As the UK population ages, we are going to be supporting more patients with ever-more complex chronic illnesses and we owe it to ourselves and to them to be at the forefront of new treatment and management guidelines. There are a number of government-produced documents to support pharmacists in this area (see tinyurl.com/chronicconditions3).

Pharmacy services to support patientsResearch has found that being diagnosed with a chronic condition can be an important moment to teach patients about health behaviour change. For example, a smoker who has just been diagnosed with chronic obstructive pulmonary disease (COPD) is much more likely to consider smoking cessation. Likewise, a patient diagnosed with hypertension or high cholesterol will be much more receptive to advice on diet and exercise.

Pharmacy services such as smoking

Smokers diagnosed with COPD are more likely to consider using a smoking cessation service

A listening earActive listening techniques are very useful when interacting with patients with newly diagnosed conditions. Techniques such as nodding your head, paraphrasing what the patient is saying, and asking questions to clarify what they have said all help to demonstrate that you are listening and trying to understand them and their needs.

Useful questions to ask patients newly diagnosed with a long-term condition include: ● how are you feeling about your new diagnosis? ● have you been involved in making decisions about your own care? ● do you have enough information to help you manage your condition? ● what extra support do you require to help manage your illness?

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cessation and weight loss programmes help to address patients’ health behaviour and promote change in these areas of their lives. Thinking about how we target resources and communications at those patients who are most at risk of developing chronic conditions is one way to reduce their incidence.

The new medicine service (NMS) was introduced in 2011 in England to support patients with chronic conditions who had been prescribed a new medication. An evaluation of the NMS carried out by Nottingham University found that the service had a positive e ect on patient outcomes, reducing hospitalisations and giving patients a better understanding of their condition and the medicines they were taking to treat it.

Once a patient has established a regular pattern of treatment for a chronic condition, they may not have to visit their GP as frequently. From this point on, a pharmacist is usually the main healthcare professional the patient will come into contact with. Services such as the medicines use review (MUR) become increasingly valuable, because the patient needs to remain compliant with their medication regime. Patients with a chronic condition can often feel tired of having to take regular medication and may choose not to be compliant. This issue can arise when the patient sees no noticeable benefit of taking the medication or if they experience side e ects. It is our role to highlight the long-term risks of not taking medicines for chronic conditions.

Pharmacists also have a key role in supporting patients whose chronic condition predisposes them to infections, by o ering the flu jab service to help keep them in good health during the times of year when they are particularly vulnerable.

Signposting for further adviceThere are a number of organisations you can signpost newly diagnosed patients to. Charities such as Diabetes UK, Asthma UK and the British Heart Foundation, to name a few, produce lots of patient literature and run support groups to ease the transition into life with a chronic disease. Each of these charities is an expert in their particular field and does a lot of research into the treatment and management of their disease.

In addition, an initiative called the Expert Patients Programme (EPP) aims to use the experiences of patients already diagnosed with chronic conditions to support newly diagnosed individuals. These expert patients know what the newly diagnosed are going through and can be a great source of comfort and support. They are able to describe what life is like after a diagnosis, what impact it will have on the patient’s life, and what the patient can do to continue to be as independent as possible for as long as possible.

Tips for your CPD entry on newly diagnosed chronic conditionsReflect How many people in the UK are a�ected by a chronic condition? How might the diagnosis of a chronic condition a�ect patients? What pharmacy services and other resources are available to support these patients?

Plan This article discusses the help and support pharmacists can provide to patients who have recently been diagnosed with a chronic condition. It includes information about the impact of the diagnosis on patients and the role of the pharmacist and pharmacy services in providing support.

Act Familiarise yourself with the diabetes risk assessment tool on the Diabetes UK website at tinyurl.com/chronicconditions1 and the NHS health check on the NHS Choices website at tinyurl.com/chronicconditions2.

Read the information about improving care for people with long-term conditions on the GOV.UK website at tinyurl.com/chronicconditions3.

Find out more about the expert patients programme on the NHS Choices website at tinyurl.com/chronicconditions4. Find out about counselling and support groups that you could recommend to patients.

Revise your knowledge of chronic conditions by completing a course on the Centre for Pharmacy Postgraduate Education (CPPE) website at tinyurl.com/chronicconditions5.

Evaluate Are you now confident in your knowledge of the advice and support pharmacists can provide to patients newly diagnosed with chronic conditions? Do you feel you can sensitively and appropriately speak to these patients?

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