Anna Hodgkinson finds working in a multidisciplinary team particularly
rewarding |
Seamless transition between primary and secondary care is essential
for patients with heart failure, which is why Lambeth Primary Care Trust,
London, bid for funding from the British Heart Foundation for a community
heart failure team.
Anna Hodgkinson took on the role of heart failure
pharmacist at the PCT last April (2007) — the first such position
to be funded by the charity.
The BHF is funding three positions at the PCT — two nurses and
Miss Hodgkinson’s post — for a three-year period.
Various elements went towards the PCT’s bid for BHF money, explains
Miss Hodgkinson. The PCT drew up a service profile against the National
Service Framework for Coronary Heart Disease which identified a service
gap in the diagnosis and management of heart failure compared with other
areas in the NSF.
“Along with that, both Guy’s and St Thomas’ [NHS
Foundation Trust] and King’s College Hospital [NHS Foundation Trust]
identified that there weren’t any heart failure services in the
community in Lambeth,” she adds.
She says that the PCT wanted to do something innovative — it was
decided that a multidisciplinary team would be the best option in Lambeth
and that a pharmacist could bring additional knowledge and skills to
the team. Community care
Within the role Miss Hodgkinson works with colleagues in both primary
and secondary care to optimise heart failure management in the community. “We
are looking at improving standards of care for diagnosis, treatment
and rehabilitation, and also for palliative care — complementing
the service already provided by other healthcare professionals,” she
says.
“The secondary care teams refer patients to us to be managed in the community,
and GP practices and community matrons can ask us for help with the management
of their patients, which we do in collaboration with other healthcare
professionals. So there are two ways of us seeing patients: one is by
direct referral from secondary care; the other is through joint clinics
with primary care clinicians,” says Miss Hodgkinson.
The team also performs home visits to reach heart failure patients who
are housebound. “Ideally,” she explains, “we try to
get our patients to see us in the clinic, but if they can’t because
of their condition or co-morbidities then we go to see them.”
She points out that a lot of liaison takes place between the community
heart failure team and secondary care. “These things only work
with good communication and good team working across the interface,” she
believes.
Each member of the team has taken a lead for certain areas.
Miss Hodgkinson links in with the heart failure team at King’s
College Hospital, where she currently works in a heart failure clinic
one morning each week.
And she has recently qualified as an independent prescriber. She elaborates: “We
had some problems with the supplementary prescribing model, especially
out in the community. Who is going to sign the clinical management plan?
It’s not practical to go around to over 50 GP practices to get
the CMP signed.”
Part of Miss Hodgkinson’s role ties in with the PCT’s medicines
management team, focusing on cardiac medicines management issues within
various practices.
She explains how this is useful: “Because I work with the medicines
management team I know what the priorities are for Lambeth PCT, so I
can ensure they are happening right through — from within the GP
practices, in our own service, and have a little bit of influence on
what’s happening in hospital as well.”
Miss Hodgkinson also critically appraises drug trials and new clinical
evidence to ensure that guidelines and practice are kept up to date. “All
of our work needs to be evidence-based,” she points out, “and
we make sure that it is done according to what has been set out nationally
and locally as well.”
She adds: “I am currently putting together some medication guidelines
for Lambeth PCT for the treatment of heart failure, which will be agreed
across the [primary/secondary care] interface.” Working together
Miss Hodgkinson acknowledges the importance of a good working relationship
with colleagues, in particular the two heart failure nurses with whom
she undertakes clinics and home visits. “Initially, when bringing
together two nurses and a pharmacist we needed to identify where the
skills of each profession crossed and complemented each other, to ensure
that our patients got the best care.” she says.
“It was about figuring out where I could tap into their knowledge and
where they could tap into mine. We haven’t had any problems with
this multidisciplinary approach.”
As the pharmacist member of the team Miss Hodgkinson says that she tends
to take on more of the medicines-related responsibilities. She deals
with patients who have complex medication issues and co-morbidities — reviewing
and optimising their prescribed medicines.
She is also involved with concordance and compliance issues and receives
plenty of medicines information queries from GPs. Miss Hodgkinson is
clearly enthusiastic about her role.
An enjoyable aspect of her job is the interaction with people from other
health disciplines, says Miss Hodgkinson, drawing special attention to
a GP with special interest in cardiology in the Lambeth area, and the
PCT’s coronary heart disease facilitator.
Furthermore, she is highly involved with education — developing
healthcare professionals’ knowledge and skills in the management
of heart failure patients. “I work with quite a range of professionals,
including community pharmacists, community matrons, practice nurses,
district nurses and GPs.”
Miss Hodgkinson says that some of the patients she sees are surprised
to hear that she is a pharmacist. “They are used to pharmacists
being in a community pharmacy or a hospital. So a pharmacist actually
coming out to visit them, or seeing a pharmacist in the clinic setting,
is quite different,” she reflects.
“Getting involved with patients is very rewarding — this is the
way that the profession is moving,” she believes. |
The
Pharmaceutical Journal