The development and feasibility testing of a community pharmacy-based guidelines for the assessment and management of acne vulgaris.

The following describes a research study commissioned by Galderma to explore the development of guidelines for community pharmacists on how to assess and manage patients who present with acne. Background: Acne vulargis (or simply acne) is an extremely common skin condition affecting up to 85% of teenagers and which, for a small proportion of individuals, can persist into adulthood. The majority of patients have mild to moderate disease which is amenable to treatment with topical acne therapies. Community pharmacies have been advocated as a first port of call for minor ailments, which includes skin conditions such as acne. While acne treatments are available over-the-counter, there is an array of different products available which can lead to confusion amongst patients and pharmacy team members. Furthermore, acne can be associated with psychosocial co-morbidities and lead to problems such as scarring hence the importance of a holistic assessment to ensure that patients are effectively managed and referred, where appropriate, to other healthcare providers. There are currently no pharmacy-specific guidelines published in the public domain to support UK-based pharmacy teams in the assessment and management of those seeking advice and or treatment for acne. The purpose of the present study was, therefore, to develop and feasibility test such a guideline to help support pharmacy teams to appropriately assess and manage patients seeking advice on acne. Method: The study was conducted in three separate phases: semi-structured interviews with consultant dermatologists; an online Delphi study; and, a quantitative evaluation. The semi-structured interviews were used to gather information for the development of the initial statements for the Delphi and the final phase was used to evaluate, from the perspectives of community pharmacists and patients, the guideline developed from the Delphi. Results: Interviews were conducted with five consultant dermatologists with an interest in acne. Emergent themes from these interviews were used, together with the literature, to develop the statements for the first round of the Delphi. A total of 49 statements were developed relating to patient consulation (7), clinical management (10), treatment (4), referral (9), lifestyle factors (16) and monitoring (3). The Delphi was conducted for three rounds with 19 panellists representing an interprofessional mix of dermatologists, GPs with a special interest in dermatology, specialist dermatology nurses, community pharmacists with an interest in dermatology, and expert patients. The response rate was 79% (n=15/19) and stable for all three rounds. Consensus level was set at 80% summative of strongly agree and agree. This was achieved for 21 out of the 49 statements, relating to: patient consultation (2/7) ; clinical management (4/10) ; treatment (1/4) ; referral (7/9) ; lifestyle factors (4/16) ; and, monitoring (3/3). In many instances, there was strong sense among panellists that assessment of acne was a role for the pharmacist rather than suitably qualified non-pharmacist staff. The final guideline was evaluated in 9 community pharmacies on 35 patients seeking advice on acne. Though limited in size, the median rating for the helpfulness of the guideline was 4 out of 5 (interquartile range 4-4) which suggested that it potentially was of value to pharmacists. Conclusion: The Delphi process, utilising an interprofessional expert group, was successfully used to create a novel pharmacy-specific guideline to support pharmacy teams when dealing with patients seeking advice on acne. Although the guideline was piloted with a small number of pharmacies, it appeared to be of value though further work with a larger number of pharmacies and patients is required to more fully evaluate the usefulness and value of the tool