The Pharmaceutical Journal
Vol 268 No 7188 p340-341
9 March 2002

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European Foundation for the Advancement of Healthcare Practitioners summary

The technician's role in a collaborative care team

Claire Joyce, of Essex Rivers Healthcare Trust, Colchester, described a multidisciplinary scheme meeting the requirements of the National Service Framework for Older People. The scheme's main aim is to enable patients to live independently in their own homes. It involves a multidisciplinary collaborative care team, which includes a full-time pharmacist, a full-time technician and a part-time community pharmacist.

The team sees around 58 referred patients per month. They have an average age of 81 years. The most common group of patients are those awaiting elective surgery. The patient needs to be medically fit and suitable for referral to the team. One or two days before discharge, there is a medication review where problems, errors and interactions are identified. Medication is discussed with the patient to identify other potential problems, eg, whether they can open child-resistant closures and read the print on labels, and to ensure patients do not continue to take discontinued medicines at home.

An individual pharmaceutical care plan is written with details that may be helpful to the patient. Ms Joyce illustrated her role by describing an 81-year-old patient who had been admitted to hospital following a fall and who had Parkinson's disease, hyperthyroidism, postural hypotension, an oesophageal ulcer and a hiatus hernia, and was on eight drugs. He lived alone, although his son visited him. To help him cope he was given a compliance aid and his son was taught how to refill it. He was also given advice, including "if he coughed up blood to contact his GP". Ms Joyce stressed the importance of using terms and language the patient can understand.

The pharmacist checks Ms Joyce's reports before they are sent out and a copy is kept for reference. The GP and community pharmacist are sent a copy and the GP uses it to update the patient's records.

Risk assessment tool

The pharmacy team is also piloting a risk assessment tool, which scores the degree of pharmacy support needed by a patient. This is based on the combination of drugs, number of drugs, frequency of doses, route of administration, reasons for admission and relevance to medication, co-existing medical conditions, home support needed, professional support available, impact of medication on lifestyle, and need for concordance. Points are allocated which are totalled. Ms Joyce's patient scored 60/100. A score of 0 to 25 results in no further action, one between 25 and 50 results in liaison with the community pharmacist and one over 50 means a post-discharge visit is arranged. In one year the team has seen 1,135 clients; of these 798 did not require further help.

Ms Joyce received extensive training for her role as a collaborative care technician. She undertook a local clinical training scheme which covered cardiovascular medicine, orthopaedics, endocrinology and care of the elderly. It was provided in-house and she was required to prepare a case history, to demonstrate effective communication and IT skills, and to pass an examination. She started by shadowing occupational therapists, physiotherapists, secretarial staff and the collaborative care pharmacists. She helped out to start with and then accompanied the community pharmacist on home visits. She found the pharmacists to be supportive and worked through problems with them and build on what she had learnt for the future. She said the qualities needed for this work were good communication and listening skills, observation, organisation, self-motivation, and an ability to know and work within her own limitations.