Pharmacy contributes to successful matron pilot
Pharmacy input at both a strategic and operational level has contributed to the success of a community matron pilot project in Harrow Primary Care Trust. The pilot prevented 45 hospital admissions over three months,
leading to a potential net saving of £284,240 per annum.
The pilot involved four GP practices and two community matrons. Nina
Barnett, a specialist pharmacist for older people for Harrow PCT, based
at Northwick Park Hospital, and a pharmacist prescriber, was on the project’s
steering group. She had a dual role in the project: at a strategic level
she identified what the community matrons should be doing in terms of
medicines management for patients and through formal carers and, at an
operational level, she acted as a medicines management mentor for the
community matrons.
Ms Barnett met the community matrons every two weeks to discuss their
patients and provide support with medicines management issues.
“The GP mentor dealt with diagnostic queries and ongoing prescribing
issues whereas I focused on what the matrons needed to look at in terms
of issues
around taking and using medicines, as well as clinical medication review,” she
told The Journal.
Last week, a review of Evercare pilots published online in the BMJ (PJ,
18 November, p597) concluded that community matrons, whose roles are
based on the same principles as the Evercare advanced primary nurses,
are unlikely to reduce hospital admissions. Ms Barnett believes that
using a combined model of care (based on the model of care developed
at Castlefields Health Centre, Runcorn, and Evercare) contributed greatly
to the success of the Harrow pilot. “Practitioner knowledge of
local needs allowed the pilot to be adapted, maximising the potential
to reduce admission rates,” she said.
Harrow PCT has decided to continue to employ community matrons beyond
the pilot project and is currently looking at how services can be redesigned
to embrace case management and care planning, using lessons learnt from
the pilot.
Ms Barnett expects to provide ongoing support to community matrons, particularly
as they begin prescribing.
Local adaptation of Evercare principles
The Harrow pilot used a practice-centred approach to identify
the target group of patients (very high intensity users) and general
practice IT systems were used as the primary source of records
to maintain effective communication and clinical governance.In
addition, the pilot used patients at risk of readmission (PARR)
data (similar to the information available to the Evercare pilots),
locally adapted criteria for identification of high intensity users
and ad hoc information from the GP practices to identify patients.
The Harrow pilot also focused on case-finding in patients over
85 years old, rather than over 65 years old (as in Evercare), since
this was the group within which it identified the most high intensity
users.The benefits of this case management approach are still becoming
evident after one year; the average length of time patients were
in the Evercare pilots was eight months. |
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