The Pharmaceutical Journal
Vol 269 No 7206 p83
13 July 2002

Report demonstrates how pharmacists can contribute to intermediate care

A new report from the Royal Pharmaceutical Society seeks to demonstrate to service commissioners how pharmacists can contribute to the delivery of intermediate care services, which bridge the gap between acute hospital care and primary/community care.

The report says that facilitating greater pharmacy involvement requires action in a number of areas, including training, practice development, shared patient records and new ways of working in loose multidisciplinary teams. Service commissioners' awareness of pharmacists' skills and potential contribution will need to be raised, as will pharmacists' awareness of intermediate care and, more generally, the implementation of the National Service Framework for Older People.

The report, prepared by Sue Burke (an independent consultant specialising in organisational and workforce development and training) and Eileen Neilson (the Society's head of policy development), begins by referring to the Government's investment programme to develop intermediate care services in England, which aims to promote faster recovery from illness, prevent unnecessary admission to hospital, support timely discharge and maximise independent living. Intermediate care services will be targeted initially on those older people who are at highest risk of entering institutional care following acute conditions such as pneumonia, hip fracture and stroke.

The report emphasises the importance of medicines and medicine-taking in the intermediate care context, and in relation to services for older people generally. It points out that adverse drug reactions are a significant factor in avoidable hospital admissions in older people. Older people are taking more medicines than ever before, with increased risks of interactions and other adverse effects. The report says that certain drugs need to be monitored in older people for safety reasons and that some drugs are particularly likely to cause problems in older people and should be replaced by safer alternatives where possible. It also refers to the National Health Service resources wasted when medicines are not taken effectively or not taken at all.

Pharmacists can help service commissioners tackle all those areas, the report says. They also have a role in client assessment, identifying older people at risk because of their medication regimen and those having problems with medicine taking. It says that medication review by a pharmacist can rationalise an over-complex regimen. Medicines no longer needed can be discontinued, and a change of formulation can help a patient take a medicine more easily and effectively.

The report says that much more could be done to promote independence and patient-centred care in older people. Pharmacists could support self-administration of medicines and provide aids to help older people in taking their medicines. They could also provide training and advice for service users, family carers and care workers.

The report includes 16 case studies. Some demonstrate how pharmacists can contribute to the five models of care in the Government's intermediate care investment programme. Others show how pharmacists can support intermediate care services by contributing to preventive measures.

The report makes a number of recommendations for intermediate care commissioners, intermediate care co-ordinators, pharmacists, pharmacy organisations and the Department of Health. It recommends that commissioners should ensure that intermediate care schemes address medication problems and should consider how to use pharmacists to tackle such problems — for example, by reviewing medication regimens, advising patients on their medicines and implementing self-administration of medicines in residential settings.

It also suggests that commissioners should liaise with the pharmaceutical adviser or primary care pharmacists for the locality on how to involve pharmacists, that they should include pharmacy and medicines in audit and evaluation of intermediate care schemes, and that they should ensure that clinical governance for intermediate care services involves input from pharmacists.

Because of the many medication problems that arise from transfers between care settings, the report recommends that intermediate care co-ordinators should pay particular attention to communication and record keeping on medicines and informing patients about their medicines. It emphasises the importance of co-ordinating different pharmacy inputs along a care pathway.

The report says that the Society should consider whether pharmacy involvement in intermediate care has implications for the undergraduate syllabus, preregistration training or continuing professional development. It should also consider the professional conduct implications of pharmacists increasingly visiting patients in their own homes or other community settings.

The report also makes a number of recommendations for action by other pharmacy bodies and the Department of Health to support and promote pharmacists' role in intermediate care. It recommends that chief pharmacists of acute trusts should examine the requirements for effective communication with doctors on prescribing, particularly at the points of admission and discharge. It says that the discharge process would be improved by setting up direct links with the patient's community pharmacy to communicate prescribing information.

The report recommends that individual pharmacists should be proactive in ensuring that intermediate care commissioners are aware of what they can contribute.

The report's final recommendation is that pharmacists, their negotiating bodies, service commissioners and other service providers should work together to set up intermediate care services that meet patients' needs and provide professionally and financially rewarding clinical roles for pharmacists.

Copies of the 40-page report are being distributed to primary care trust chief executives, directors of social services, intermediate care commissioners and others. Copies can also be obtained from Karen Turnham, Royal Pharmaceutical Society, 1 Lambeth High Street, London SE1 7JN (fax 020 7572 2501; e-mail kturnham@rpsgb.org.uk) or by downloading it as a PDF file from the policy section of the Society's website.