Examples of pharmacist involvement
in care pathways and service redesign
Chronic obstructive pulmonary disease
Claremont practice in Devon employs a community pharmacist for one
day a week to work with patients who have chronic obstructive
pulmonary disease. Through domiciliary visits for the severe housebound
patients, medication reviews, running COPD clinics and reviewing
the COPD register, major savings have been achieved for the practice
as well as better outcomes for patients.
Diagnostic services
In Derwentside PCT community pharmacists are providing international
normalised ratio measurement services in community pharmacy-based
clinics or in patients’ homes. This has led to a reduction
in ambulance transport costs, an increase in accessibility and
capacity of this service and enables all practices to have access
to community based anticoagulant monitoring (a PCT target).
Medicines management
In-depth assessment is used to develop tailored medicines management
solutions for vulnerable older people living in the community
in Poole. Pharmacists and pharmacy technicians provide intensive
support for patients, developing pharmaceutical care plans that
enable patients to administer their own highly complex medical
treatments safely.
The service works closely with secondary care
to improve the patient experience after discharge and is linked
through a service level agreement with local community pharmacies
to provide an enhanced pharmacy service. Specialist nurses,
GP practices and social care services are also involved. Long-term conditions
A practice in Exmouth has employed a pharmacist for one day a week
to review certain patients with long-term conditions. Over a period
of a year the contribution of the pharmacist has resulted in an
estimated £4,566 being saved on the prescribing budget.
Medicine use reviews
Medicine use review is an advanced service under the contractual
framework for community pharmacists. In Hampshire and the Isle
of Wight, community pharmacists have been requested to use MURs
to
target patients currently on osteoporosis agents.
The pharmacist checks that the patient is adherent to the regimen
and discusses intake of calcium via diet or adjunct therapy. The
MUR also includes a falls risk assessment. This service has led
to an improvement in access, particularly for hard to reach at
risk patients, and improvements in adherence and in calcium and
vitamin
D3 intake. This, in turn, has led to a reduction in falls and
a reduction in emergency admissions and secondary care costs.
Cost minimisation and medicine management in nursing homes
In Havering PCT a service has been designed to minimise drug wastage
for nursing home residents through application of an agreed prescribing
policy and structured medicine reviews by a community pharmacist.
The pharmacist identifies clinical and clerical prescribing issues
for resident patients, which are then put to the GP for action.
This service supports the National Service Framework for Older People
and has resulted in a reduction in the number of unnecessary medicines
that elderly patients take, an improved quality of life for residents,
a reduction in side effects requiring admission to hospital, a reduction
in falls, a reduction in overall treatment costs and a use of savings
in part-time GP recruitment to look after nursing home patients.
The service has resulted in a 60 per cent reduction in prescribing
costs and on average the work of the pharmacist resulted in 4.5
recommendations (3 clinical, 1.45 clerical) per patient. Of these,
one in every three clinical recommendations led to a discontinuation
of medication and one in every 1.5 clerical recommendation led to
removal of unwanted medicines from the patient’s
record. |
The
Pharmaceutical Journal