|
Helen Williams, MRPharmS, is specialist cardiac
pharmacist at King’s College Hospital, Lambeth and Southwark
Primary Care Trusts and coronary heart disease
adviser to London, Eastern and South East Specialist Clinical Pharmacy
Services.
Sotiris Antoniou, MRPharmS, is
senior directorate pharmacist at Barts and The London NHS Trust
and
chairman of the UK Clinical Pharmacy Association cardiac committee.
Correspondence
to:
Ms Williams
e-mail helen.williams@lambethpct.nhs.uk |
Thirty-two local cardiac networks have emerged in England from the
work undertaken by the Coronary Heart Disease Collaborative programme,
which
was funded nationally to support the delivery of the service standards
laid out in the 2000 National Service Framework for Coronary Heart Disease.
The networks are supported by a national team, known as the “Heart
improvement programme” with a remit to ensure the networks are
delivering improvement in service and to share examples of innovation
in clinical care. Details of the networks and how to contact them are
available on the internet at www.heart.nhs.uk.
Goal
The goal is to improve the experience and outcomes for people who have,
or who are at risk of developing heart disease, by redesigning the
whole pathway of care across primary, secondary and tertiary care
sectors. This is achieved through working with managers, clinicians and
service
commissioners to review how cardiac care is provided, taking into
account the views and experiences of local patients.
Such a collaborative approach allows issues to be identified and
addressed across organisational and geographical boundaries to facilitate
a whole
system approach to service improvement. For example, the development
of primary angioplasty services in the management of acute myocardial
infarction has involved inter-professionals collaboration to reconfigure
service delivery across district general hospitals, tertiary referral
centres and local ambulance services.
The work plan of the individual networks will be driven by local priorities
and may include clinical and strategic issues (see Panel below for
examples).
Examples of work areas from North and South East London cardiac
networks
• Revascularisation
• Heart failure
• Arrhythmias
• Rehabilitation
• Disease prevention
• Cardiac prescribing forum
• Workforce development |
National priorities can also be incorporated including: • Ensuring equity of service provision
• Improving access to healthcare
• Simplifying and accelerating referral processes
• Addressing the 18-week wait target
• Implementing the Patient Choice programme
• Informing the commissioning process
• Increasing public engagement in health care
Delivery of service improvements is facilitated by local implementation
teams working across the sector.
Pharmacist involvement
So why should pharmacists get involved? Pharmacists have much to contribute
within the context of a cardiac network, as medicines management
is a major issue for this group of patients.
This contribution will become increasingly important as networks
move from a focus on system issues, such as referral pathways, to
a focus
on improving clinical care. Engagement of the multidisciplinary health
care team within the cardiac networks can facilitate the development
and implementation of evidence-based and cost-effective prescribing
strategies across a whole sector, with the advantage of reducing
duplication of
effort across organisations.
Using the networks to achieve consensus on prescribing issues will
facilitate consistent approaches between organisations and across traditional
boundaries,
such as that between primary and secondary care. This will require
close liaison between network prescribing groups and drug and therapeutics
committees of local acute trusts and primary care organisations. Network
endorsement may be critical to the successful implementation of new
prescribing
guidance for cardiac patients in future and, therefore, it is essential
that pharmacists recognise their potential.
Pharmacist involvement should be representative of all aspects of the
service, including specialist clinical pharmacists from acute trusts,
prescribing advisers from primary care organisations, practice-based
pharmacists and community pharmacists. How pharmacists engage in their
network will depend on their local structure and current work priorities.
As part of the health care team providing services to cardiac patients,
pharmacists have an opportunity to flag medicines management issues
and hence direct the network work plan as it evolves over time. For
example,
pharmacists could develop a forum for discussing prescribing issues
within a cardiac network. They could ensure representation from all
stakeholders
and relevant organisations. In particular, they could help identify
local priority areas. For example: • Setting cholesterol treatment targets
• Developing and implementing statin switch policies
• Defining appropriate use and duration of clopidogrel for cardiac indications
• Implementing relevant new National Institute for Health and Clinical
Excellence technology appraisals and guidance on atrial fibrillation
and hypertension, and proposed guidance on secondary prevention of myocardial
infarction and use of ezetemibe
• Horizon scanning for new drugs or indications
• Addressing primary/secondary care interface issues
• Identifying and rolling out good practice within the network
• Identifying and addressing prescribing training needs within the network
Pharmacists can find out more at the NHS Heart Improvement Programme
by visiting its website at www.heart.nhs.uk. From there, they can get
in touch with the local cardiac network lead within their organisation
or contact their local network executive team directly.
They should identify local work priorities and consider the current and
potential contribution that pharmacy could make within those areas. We
call on our pharmacist colleagues to get involved. |
The
Pharmaceutical Journal