The Pharmaceutical Journal
Vol 271 No 7256 p17
5 July 2003

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Better management of skin conditions in prison through pharmacist-led clinic

The winners of the Pharmaceutical Care Awards 2002 were presented with their awards at a dinner held at the Savoy Hotel in London on 27 June. The awards, organised by The Journal and sponsored by GlaxoSmithKline, were presented by Professor Martin Kendall. Finalists presented their work at a conference held in the afternoon before the dinner

A pharmacist-led dermatology clinic

Dr Rod Tucker MRPharmS (forensic medical services, HMP Moorland, Doncaster)

A pharmacist-led dermatology clinic in a prison won Dr Rod Tucker the award for innovation in primary care. The clinic, at HMP Moorland in Doncaster, demonstrated that pharmacists can take on greater responsibility for the management of chronic skin conditions.

The aims of the pharmacist-led clinic were to improve patient care, educate patients and reduce waiting times for accessing health care. Usually, prisoners have to apply for an appointment with a medical officer to access health care. Making the dermatology clinic the first port of call helped to reduce waiting times.

At the clinic, patients are given appointments, each lasting for between 10 and 15 minutes. During this time, the pharmacist takes a history and examines the patient. "We can initiate treatment, offer advice or refer the patient to the prison doctor," Dr Tucker explained. Patients are also seen again at a follow-up appointment.

"On average we are seeing 60 to 65 patients a month," said Dr Tucker. The clinics are ongoing but an assessment of the first 227 patients showed that 45 per cent consulted the clinic about asthma, 26 per cent about eczema, 11 per cent about fungal infections, 10 per cent about psoriasis and the remaining 10 per cent about other skin conditions.

To improve patient care, the clinic allows patients to select an emollient or topical acne therapy after sampling the available products. "Patients choose the one they want so this increases use," explained Dr Tucker. The clinic also introduced a scheme to allow patients to purchase certain skin products such as anti-bacterial skin washes giving the patients some degree of self-management. In addition, patients are educated about their skin conditions and its management.

The pharmacist-led clinic has developed to such an extent that prisoners with skin problems now apply to see the pharmacist rather than prison medical officer. This is backed by analysis of the patients' outcomes. For example, 77 per cent of patients with acne had their symptoms controlled by topical therapy alone and all flare-ups of eczema were managed successfully with either hydrocortisone or Eumovate.

"The project showed that pharmacists can manage common skin problems in this setting. Patients felt informed about their condition and its management," concluded Dr Tucker. "The clinic had a positive impact on waiting times and reduced pressure on the prison medical officers."

FINALIST: Meeting the National Service Frawework for Older People targets in falls and medication reviews

Pills and spills

Ashley Harling MRPharmS (project manager, Pills and Spills), Liz Reid MRPharmS (pharmaceutical adviser, South Manchester PCT), Karen O'Brien MRPharmS (pharmaceutical adviser, Central Manchester PCT), Ruth Thornton (district nurse and South Manchester PCT lead for older people), Chris Hale (single assessment lead, Manchester Social Services), Maggie Walker (Care and Repair), Dr Mark Holland (falls consultant, Wythenshawe Hospital) and Dr Helen Hosker (general practitioner)

A project that reduced the number of inappropriate medicines prescribed to older people and the risk associated with falls was awarded the runner-up prize in innovation in primary care.

The project involved a pharmacist reviewing patients' medicines and conducting a holistic assessment of their needs. Pharmacists were given additional training to carry out fall risk assessments and to take blood pressure. "Pharmacists are not looking just at medicines but at all the patient's care," said Ms Harling.

This review not only identified medicine-related problems but also provided the opportunity to refer patients to other services available within the multidisciplinary team. Some patients were also given information leaflets by the pharmacist. "This was particularly important for patients who are housebound," said Ms Harling.

The project was piloted in a variety of care settings: two GP practices, a nursing home, a residential home and an intermediate care facility. About 200 people have been seen so far.

The group concluded that the project established a "gold standard service" which supported the targets on falls and medicines reviews in the National Service Framework for Older People. "It enabled older people to maintain independence for longer," said Ms Harling.

In addition, it improved multidisciplinary working and increased information sharing in the team.