All posts by Boehringer Ingelheim

Tackling the growing burden of IPF

Sarah Agnew and Annette Duck, ILD specialist nurses based in the NorthWest of England – a region dealing with the greatest prevalence of Idiopathic Pulmonary Fibrosis (IPF) in the country – outline the challenges and the way ahead in tackling the impact of this deadly disease

More than 4,200 people are now living with idiopathic pulmonary fibrosis in the North West alone, the highest population of patients with this fatal lung disease in England, a network meeting of specialist respiratory nurses heard recently.1

Understanding this figure is critical because it’s a reflection of the referrals we then see in our services, says Sarah Agnew, ILD specialist nurse at Aintree NHS Trust. “However, our referral rate for IPF is only around 150-200 patients a year – so where are these individuals, and why aren’t they being referred to specialist centres?”

Whatever the situation, Sarah explains, there is a clear impact on service provision – both currently and in the future. “These patients should be seen by a specialist centre and having specialist input – particularly in hotspot areas – even if it’s just to get a confirmed diagnosis from a multi-disciplinary team as set out by the NICE Quality Standards2.”

With this in mind there is also a distinct possibility the condition is under-diagnosed, Annette Duck, independent ILD specialist nurse adds. “I suspect a number of patients are under the care of general chest physicians and are not referred to specialist centres where a true diagnosis would be made,” she stresses.

Overcoming diagnosis challenges

“So although things are improving, under-diagnosis, mis-diagnosis and a lack of awareness of both services and available treatment remains,” Sarah points out. Even among those individuals referred to specialist centres, around 20% will be given an alternative diagnosis – usually another ILD, or even COPD, she says.

Ultimately, Annette adds, these are complex conditions to diagnose even with specialist expertise and it is critical these patients are picked up earlier in the pathway. “We still have cases where patients are referred to us with evidence of significant disease progression but because of the length of time it’s taken to get to specialist care may be towards the lower end of the eligibility criteria for treatment – when we know people are less likely to tolerate the drugs – or indeed too advanced to receive medication.”

So one major challenge in diagnosis and care, both Annette and Sarah stress, is ensuring patients are referred from GP to general chest clinics into the specialist ILD multi-disciplinary team. “The red flag for GPs should be an individual presenting with cough, crackles and breathlessness on exertion,” says Annette. “We have to recognise that GPs are under a huge amount of pressure so we have to make it simple, we have to make it snappy, it’s got to be one of their targets.”

Tackling resource shortfalls

Then, it’s having the resource in place to manage the sheer number of patients coming through to specialist centres. Currently, Sarah explains, the ability – or inability – to access specialist respiratory nurses is “a big problem in the centres around England. There just aren’t enough to go around.”

So ensuring patients are sent to the specialist centre, having the resources to be able to see them in a timely manner and accessing the support required to be able to treat and manage these individuals is a significant problem, they note. “We should not have to compromise the care we give because we haven’t got the resources in place.”

One way to overcome this hurdle, say Annette and Sarah, is to ensure information is cascaded down from the specialist centres to those on the front line in primary, secondary and tertiary care. In my view, says Sarah, we need more ILD training in the UK to educate GPs, practice nurses, community nurses and palliative care services – not only about the need for early diagnosis and symptom checkers – but the level of local care and support required for people living with IPF. “It’s a team effort, we’re all in this together.”

Of course, the provision of education and information extends not only to HCPs throughout the care pathway, but to the patients and families themselves.

“Patients are understandably frightened and come into clinic wanting to see a healthcare professional who understands their diagnosis; they’re hungry and desperate for information about their disease and their future prognosis.”

The information cascade

Although the information given to patients is vastly improved compared to five years ago, a large number of individuals and their families are still attending clinic armed with very little understanding or knowledge of their condition or the services they are entitled to, Sarah adds. After diagnosis, it’s about empowering patients to go to their GP and tell them that they’ve got a serious condition and they need help – and how to access information and support in the community.

“Patient power is critical – if the individuals and their relatives stand up and start mobilising the patient voice it will bring IPF out from under the radar and ensure it is made a greater priority at government level.”

“But equally we can’t forget how far we’ve come,” they say. “This isn’t the time to take our foot off the accelerator and pat ourselves on the back, the key thing is to keep the momentum up and continue pushing forward.”

References

UK/RESP-161434    Date of preparation: October 2016

Provide high quality care for people with IPF

inspiration-2-front-pageIPF World Week, which ran 17-25 September, saw a flurry of multimedia activity across the globe to raise awareness and knowledge of Idiopathic Pulmonary Fibrosis (IPF) – a rare and little understood fatal lung disease with escalating patient numbers and a substantial and disproportionate impact on individuals, carers, families and healthcare services.1, 2, 3 

This “social emergency”, says the European Idiopathic Pulmonary Fibrosis & Related Disorders Federation (EU-IPFF), raises the flag for greater awareness of IPF among key stakeholders and better access to care and services for patients – sentiments that were central to the ethos for creating the latest issue of Inspiration.4

Launched in IPF World Week, Inspiration 2 brought together leading clinicians, patients, carers and advocacy organisations to explore access to treatment, support and services for people living with IPF in the UK. As Professor Mike Morgan, National Clinical Director Respiratory, NHS England, explains in the foreword: “Inspiration 2 contains a stark view of the realities of IPF and the challenges we face to provide high quality care and support for all those affected. It would be nice to think that in England we can develop a system of care for such patients that will become the envy of the world.”

As one of 200 orphan lung diseases, IPF comes with a prognosis that is often worse than for lung cancer. Yet unlike the picture for cancer in the UK, where if a GP suspects a malignancy they must refer to a specialist within two weeks of presentation, no such targets exist for any respiratory disease other than lung cancer. As a consequence, it can still take up to two years for patients with IPF to be diagnosed after experiencing their first symptoms.2

For Fiona Ballantyne, a 49-year-old IPF patient who finally received her diagnosis in February 2016 after years of breathing difficulties, this was certainly the case.

Despite being referred for further tests in August 2014 after contracting pneumonia – and receiving subsequent steroid treatment – it wasn’t until Fiona’s consultant referred her for a lung biopsy in December 2015 that an accurate diagnosis was given.

In an interview in Inspiration 2 Fiona – who also received broad coverage in the Scottish press – revealed she felt “numb and scared” when she was first informed she had IPF, but remains optimistic for the future after recently being told she is too healthy for a lung transplant.

“It is great to be able to give the patient perspective in this second edition of Inspiration,” notes Ruth Sabella, Project Manager at the British Lung Foundation. “Throwing the spotlight on IPF is important in helping raise awareness and funds for research into this little known condition.”

Although a recent global survey of more than 120 people living with IPF found nine out of 10 patients were happy with the way their doctor informed them of their diagnosis, participants also suggested having access to information about the support, treatment and realities of living with IPF would have been helpful,5 a point echoed by Fiona in Inspiration 2. “In my view the information supplied to patients could be improved as most of my knowledge and understanding comes from my own research.”

Inspiration 2 champions the huge advances that have been made in IPF care and sets out the collaborative vision for the future, epitomised in the words of Professor Morgan: “In the past, people with IPF have had very little support. Although things have improved with the introduction of evidence-based treatment – including new drugs and rehabilitation – it is important these are correctly delivered to all those who would benefit.”

Many believe with the number of people being diagnosed with IPF in the UK steadily increasing year on year, government and policymakers need to start prioritising this condition as though it were a cancer.

Boehringer Ingelheim, working with pharmaphorum media, unveiled the first issue of Inspiration6 on Rare Disease Day 2016 to raise awareness of IPF and the need for early and accurate diagnosis of this devastating condition. Inspiration 2 evolves the story by exploring the current care and treatment pathway for IPF patients – and the hopes for the future.

References

  1. Navaratnam V et al (2011) Thorax doi:10.1136/thx.2010.148031 (http://thorax.bmj.com/content/early/2011/03/29/thx.2010.148031.full) (Last accessed September 2016)
  2. British Lung Foundation (2016) The Battle for Breath https://www.blf.org.uk/what-we-do/our-research/the-battle-for-breath-2016 (Last accessed September 2016)
  3. Action for Pulmonary Fibrosis (2016) Fit for the Future: Future-proofing care for patients with IPF http://www.actionpulmonaryfibrosis.org/research/fit-for-the-future-future-proofing-care-for-patients-with-ipf/ (Last accessed September 2016)
  4. Inspiration 2 (2016) https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/Inspiration2FINAL.pdf (Last accessed September 2016)
  5. Data on file. Boehringer Ingelheim. DOF NIN16-13 Think of Everything Global Patient Survey 2016 (Last accessed September 2016)
  6. Inspiration (2016) https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/IPFreport.pdf (Last accessed September 2016)

UK/RESP-161432 Date of preparation: September 2016

Calls for urgent focus on IPF as cases double

Idiopathic pulmonary fibrosis (IPF) should now be given the same attention as cancer, says Dr Toby Maher, Consultant Respiratory Physician at the Royal Brompton Hospital, after new data showed more than double the number of people are now living with the deadly lung condition than previously thought1.

More than 100 patients, their families and carers, alongside healthcare professionals and researchers, gathered recently at the Royal Society of Medicine to hear that around 32,500 people in the UK are now living with IPF – a far greater number than the 10,000 to 15,000 identified in earlier figures1.

These data, from the British Lung Foundation’s three-year Respiratory Health of the Nation project – the first research of its kind in the past 10 years – also reveal that one in every 100 deaths in the UK is now caused by IPF, more than many better known conditions such as leukaemia, stomach, liver and skin cancer1.

If IPF were a cancer, it would be the eighth most common cancer in the world2. IPF has no known cause, is often misdiagnosed, there are few treatments and no cure.

So isn’t it time we sat up and paid attention?

Here in the UK, if a GP suspects a malignancy they are obliged to refer that individual to a specialist within 2 weeks of presentation and people should expect to start treatment within 2 months of the referral6.

In stark contrast, the average time to diagnosis for an IPF patient is one to two years following the onset of symptoms and the prognosis may be as bad as, or even worse than it is for lung cancer. Indeed, half of all people with the condition will not live more than three years from diagnosis.3, 4

“This adds more weight than ever to our calls for IPF care in this country to be improved,” says Dr Maher. “We need NICE Guidelines to be followed in full, for all patients to be given access to a specialist nurse to help them manage their disease, and for better signposted pathways of care with rapid access to specialist centres to ensure accurate, early diagnosis and treatment for all patients with this life threatening condition.”

These standards are common for people with cancer. As the British Lung Foundation says, now we know just how many people it affects, there’s no reason why people with IPF should get a lesser standard of care.

With the publication of a recent article in the Telegraph entitled Agonising mystery lung disease twice more widespread than previously thought, finally the general public are being exposed to the facts about this devastating condition.

—————

IPF is a little known but fatal respiratory disease – characterised by permanent scarring of the lungs that makes it increasingly difficult to breathe. The impact of this disease is highlighted in Inspiration, a landmark report published on February 29th 2016 to mark Rare Disease Day and designed to raise awareness of the need for early and accurate diagnosis of this fatal lung disease.3

Inspiration, developed by Boehringer Ingelheim and pharmaphorum media, is the result of a collaboration between patients, patient organisations and leading clinicians, and can be found here: https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/IPFreport.pdf

References

  1. British Lung Foundation (2016) https://www.blf.org.uk/support-for-you/idiopathic-pulmonary-fibrosis-ipf/statistics/what-you-need-to-know [Last accessed April 2016]
  2. M. Antoniou, E.K. Symvoulakis, G.A. Margaritopoulos, C.Lionis, A.U. Wells, “Early diagnosis of IPF: time for a primary-care case-finding initiative?, “ The Lancet, vol. 2, pp. e1 (Correspondence), 2014 [Last accessed April 2016]
  3. NHS Choices Pulmonary Fibrosis (Idiopathic) http://www.nhs.uk/Conditions/pulmonary-fibrosis/Pages/Diagnosis.aspx [Last accessed April 2016]
  4. Richeldi L (2015) Idiopathic pulmonary fibrosis: moving forward. BMC Medicine 13:231 http://www.biomedcentral.com/1741-7015/13/231 [Last accessed April 2016)
  5. Inspiration, Boehringer Ingelheim. Available here: https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/IPFreport.pdf [last accessed April 2016]
  6. http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/waiting-times-for-tests-and-treatment-after-cancer-diagnosis

Date of preparation: May 2016
UK/RESP-161095

Idiopathic pulmonary fibrosis (IPF) – isn’t it time we sat up and paid attention?

This is how Dr Hilary Jones ends his foreword in Inspiration, a landmark report published on February 29th 2016 to mark Rare Disease Day and designed to raise awareness of the fatal lung disease Idiopathic Pulmonary Fibrosis.1

In the UK alone, more than 15,000 people have IPF,2 characterised by permanent scarring of the lungs and loss of lung function over time.3 Yet despite these relatively large numbers, the average time to diagnosis is one to two years following the onset of symptoms – partly because the symptoms of IPF are similar to those of other, more common, lung conditions like asthma and COPD.Half of patients with the condition will not live more than three years from diagnosis.4

What might make IPF stand out though is the distinctive crackling sound that a doctor might hear when they put a stethoscope to the chest of a presenting patient.4

Although classed as a rare disease, the scale of the condition is such that it is forecast there will be 20,000 hospital admissions related to IPF in 2020, costing the NHS £20 million,5 and patient groups Action for Pulmonary Fibrosis and the British Lung Foundation – which participated in the report alongside patients and leading clinicians – believe much more could be done to raise awareness of the need for early and accurate diagnosis of IPF.

Why is it important to sit up and pay attention?

The relief often felt by patients on receiving a diagnosis of IPF can be short-lived when they realise the prognosis may be as bad as, or even worse than, it is for lung cancer.6 There are limited treatment options and no cure. Worse still, no-one knows the cause. On top of this the number of people with IPF and other interstitial lung diseases is increasing every year.4 But awareness among GPs, and difficulties in diagnosis, mean this is likely to be just the tip of the iceberg.

This was the driving force behind the production of Inspiration.

Inspiration, developed by Boehringer Ingelheim and pharmaphorum media, is the result of a collaboration between patients, patient organisations and leading clinicians, and can be found here: https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/IPFreport.pdf

References

  1. Inspiration, Boehringer Ingelheim. Available here: https://www.boehringer-ingelheim.co.uk/content/dam/internet/opu/uk_EN/images/IPFreport.pdf [last accessed March 2016]
  2. The British Lung Foundation, and the British Lung Foundation report, Lost in the system – IPF: the patient experience in England (https://www.blf.org.uk/Page/IPF-report-Lost-in-the-System#ipf-report ) [Last accessed March 2016]
  3. NHS Choices Pulmonary Fibrosis (Idiopathic) http://www.nhs.uk/conditions/pulmonary-fibrosis/Pages/Introduction.aspx [Last accessed March 2016]
  4. NHS Choices Pulmonary Fibrosis (Idiopathic) http://www.nhs.uk/Conditions/pulmonary-fibrosis/Pages/Diagnosis.aspx [Last accessed March 2016]
  5. Navaratnam V et al “The Increasing Secondary Care Burden of Idiopathic Pulmonary Fibrosis: Hospital Admission Trends in England From 1998 to 2010,” Chest Journal, vol. 143, no. 4, 2013.
  6. Richeldi L (2015) Idiopathic pulmonary fibrosis: moving forward. BMC Medicine 13:231 http://www.biomedcentral.com/1741-7015/13/231 [Last accessed February 2016)

The Buzz is back in BI by Lee Gittings, Director of Sales, Boehringer Ingelheim UK and Ireland

Lee GittingsIt has only been a month or so since I took up the role as UK Sales Director here at Boehringer Ingelheim (BI) but already I have been hugely impressed with the passion and enthusiasm of my colleagues.

BI is going through some of the most significant changes in its long and illustrious history but there is great optimism for the future. It was crystal clear at our national sales conference last month that our teams are up for the challenges thrown up by the changing customer landscape and as one colleague told me, “the buzz is back in BI”.

However we cannot rest on our laurels – we need to make sure that BI is at the forefront of the pharmaceutical industry when it comes to the evolution of our customer-facing models. As such, we need to look within our own organisation and outside for people who have a deep understanding of the emerging multi-stakeholder environment, as well as clinical expertise.

Of vital importance to BI are our therapy area specialists (TAS) who can deal with our customers on a peer-to-peer level. Key to their role is an ability to guide clinical customers so they can have more meaningful discussions with payers, equipping them with insightful local data that will change behaviours and benefit patients in improving access to our innovative medicines.

We are looking to expand our TAS force and want to talk to people who have got a strong track record working in hospitals who can offer great clinical credibility. If they have had some interactions with payers, that is great too, but not essential.

Candidates’ expertise does not have to be in the therapy areas where we are already market leaders, such as diabetes, cardiovascular and respiratory. Also, as well as having a past to be proud of, BI offers much to the new generation and we are always on the lookout for fresh graduates who are ‘tech-savvy’ and have good personal skills.

What BI wants is people who are receptive to learning and developing new skills, people who understand these new customer relationships and can speak their language.  People who can listen to our customers and are interested (not just interesting); we want people who can apply their expertise to offering compelling propositions and outcomes for the benefit of patients and our company.

It is a wonderful opportunity for all of us at BI to be part of something great. What gets me out of bed in the morning is knowing that we are playing a critical part in providing better patient care and outcomes.

3 ‘Must Dos’ for better partnerships between the NHS and Pharmaceutical Industry

The Lonely Road

Working with the NHS as a Strategic National Account Manager for Boehringer Ingelheim can be a joy, a frustration and sometimes a lonely experience. It’s great to be able to celebrate projects that improve patients’ lives, but there are other times when people make a negative judgement about working with a pharmaceutical company on preconception and that’s really frustrating. The lonely times come as a result of working alone to drive projects through a myriad of internal and external processes. It’s that principle that drove me to try something different.

 What we’ve learnt from partnering with the NHS

Earlier this year, I partnered with the Leadership Academy by undertaking the Mary Seacole Leadership postgraduate certificate course. During this I learnt about the work that the Leadership Academy had done with another pharmaceutical company on the Fellowship programme. I thought that the principle made a lot of sense and started to gain approval to run the same programme at Boehringer Ingelheim. Continue reading 3 ‘Must Dos’ for better partnerships between the NHS and Pharmaceutical Industry

Stay Well This Winter Dr Jas Kalsi’s Top 5 Tips for protecting your health over the winter months

What can you do to improve your health over the winter?

We want to show our support for the NHS Stay Well This Winter campaign. We believe that everyone should take responsibility over the winter to look after themselves and their loved ones, by making simple changes to their lifestyles.

Here are some helpful tips to help you stay healthy over the winter months, most of which are fairly easy to do!

Dr Jas Kalsi’s top 5 tips for winter health:

  1. Have a flu jab – Call into your local pharmacy to see if you are eligible for a free NHS flu jab. Even if you are not eligible they are available for around £10 and can help protect you against the flu – Money well spent! Your pharmacist is a trained healthcare professional and can also provide you with helpful tips and advice if you are unwell over the Christmas period. They are only round the corner and you don’t need to book an appointment!
  2. Keep warm – Try to keep your home at a minimum of 18° This is particularly important for elderly people or young children. Extend your Christmas goodwill to your elderly neighbours. Try to check in on them over the winter, make sure they are warm and well. You’ll both feel better for it.
  3. Maintain a healthy diet – A balanced diet, with a colourful plate full of fresh fruit and vegetables will provide vitamins such as Vitamin C to support the immune system. Did you know…Peppers also contain vitamin C, it’s not just citrus fruits! You can also consider adding a multivitamin supplement to your diet during the winter months.
  4. Look after your gut – We all love to treat ourselves to an extra mince pie or glass of wine, but remember overindulging can cause a strain on your digestive system. If you are experiencing digestive problems, your pharmacist can recommend a suitable product to help you get back to your normal self.
  5. Don’t stop exercising just because it’s cold outside – Try and do four sessions of activity each week to increase your heart rate. Even a walk in the park counts and you’ll soon warm up. You can even practice your dance moves for the Christmas party! Over time, you should also feel fitter and you may even drop a few excess pounds.

We hope you have found these tips helpful and we wish you a happy and healthy Christmas and a peaceful new year.

Download Dr Jas Kalsi’s top 5 tips here!

Greg Woodley, Marketing and Communications Director at Roy Castle Lung Cancer Foundation

Guest Post: #Beatboxcough

Greg Woodley, Marketing and Communications Director at Roy Castle Lung Cancer Foundation
Greg Woodley, Marketing and Communications Director at Roy Castle Lung Cancer Foundation

To everyone at Boehringer Ingleheim I would like to say thanks for supporting Lung Cancer Awareness month this November. We would also like to say a huge thanks to all those involved in the Beat Box Collective Cough Campaign for delivering a truly innovative and impactful campaign  which is really going to make a difference.    I’m the Marketing Director at Roy Castle Lung Cancer Foundation and it is some of the best awareness work I’ve seen.  We’re the only Lung Cancer charity in the UK and we’ve been fighting lung cancer for 25 years – I’d like to tell you a little about one of the biggest cancer challenges the NHS faces.  Continue reading Guest Post: #Beatboxcough

Using the WWHAM Pathway in pharmacy to open up a sensitive conversation with patients

The WWHAM Pathway is a tool commonly used in pharmacy to support both pharmacists and counter assistants in opening up a conversation with patients and finding out more about their condition. Generally, pharmacy teams are familiar with the WWHAM questions and how they can be best used in order to deal with common ailments.

Understanding the WWHAM Pathway:

  1. Who is the medicine for? Customers may be asking on behalf of someone else
  2. What are the symptoms? Pharmacy staff can expand on this question to get a full understanding of the symptoms
  3. How long has the patient had the symptoms? Minor ailments can clear up within a few days. Somebody who is experiencing long term symptoms may need to speak to the pharmacist.
  4. What Action has been taken already? This will avoid recommending the same product that a customer has already tried. If a product hasn’t worked it may be best to refer them to the pharmacist.
  5. Are they taking any other medication? This includes prescribed medicines and OTC, herbal or other supplements which can interact with other medicines.

Continue reading Using the WWHAM Pathway in pharmacy to open up a sensitive conversation with patients

The Changing Face of Pharmaceutical Sales

Anna Race
Anna Race

The pharmaceutical industry is rapidly changing. Our customers and the economic environment are changing. Our family owned structure has allowed us the flexibility to invest over many years in new medicines, our people and our business.

But as we see the pace of change accelerating, we have to prepare ourselves to be successful in the future.

So, as we begin to work differently with our partners in the NHS (see for example our guest post from Fran, our NHS Leadership Fellow), we also need to think differently about the roles our own people do. For example, we are now focussing on the work of the ‘Key Account Manager’. Continue reading The Changing Face of Pharmaceutical Sales