PJ Online | MM: How pharmacists and GPs are working to improve concordance

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Medicines Management
Issue no 4, p9-10
July/August 2002

Features

How pharmacists and GPs are working to improve concordance

Pharmacists and GPs in Exeter have developed a medication review/repeat dispensing system designed to help elderly patients take their medicines appropriately.
Sam Crowe reports

Sam Crowe is a freelance writer

Pharmacists and GPs are sharing information about a selected group of patients on multiple medicines in a pilot project aimed at synchronising dispensing and improving the appropriate use of medicines.

This symbiotic relationship would not be possible were it not for the fact that Exminster Pharmacy actually shares the same premises as the GP surgery involved in the pilot and because most patients who use the surgery also use the same pharmacy.

Paul Stevens, community pharmacist at Exminster Pharmacy, says: "Basically it is a repeat dispensing project where we have attempted to bring all the selected patients into a synchronised dispensing arrangement. In the first instance, patients are invited for a medication review, and after that are put on a six-month repeat prescription."

The pilot is being carried out under the umbrella of the first-wave medicines management collaborative run under the auspices of the National Prescribing Centre, to which five practices have signed up within the Exeter PCT area.

How system is automated

The project uses a computer system to automate the dispensing for patients on long-term medications — all of whom are over the age of 60. Further efficiencies come because the pharmacy is located on the same premises as the practice, so that the system avoids the GPs and the receptionists having to handle repeat prescriptions (except for signing the prescriptions).

Before the next batch of medicines are due to be dispensed, the pharmacy's computer automatically searches for the patient, and then brings their details and medication record up for the pharmacist to examine.

At the same time, the system acts as a prompt to the pharmacist to call in the patient to collect their medicines, without having to bother the surgery's receptionists.

In this way the pharmacist can access the prescribing screen of the practice's computer system. From this screen, the pharmacist can suggest changes to the way that medicines are dispensed, in order to synchronise and rationalise patients' medications. They do not have access to the clinical notes, just the prescribing screen from the GP's computer.

Benefits for receptionists

Exminster GP Dr Simon Rains estimates that the practice receptionists spend between one and two hours a day processing repeat prescriptions. But he adds: "The hope is that this scheme will help us to free up receptionists' time so they can do other things like phlebotomy. It is about taking all of the unnecessary steps out of the process."

Additional resources to pay for the extra manpower required by the pharmacy to carry out the scheme were found from within local prescribing budgets.

Effective use of medicines

Dr Rains says that the system also helps them manage medication use more effectively.

"If the pharmacist can see what medication the patient is on then they can help to ensure that their medication is correct all of the time, even when patients come in for OTC preparations."

Mr Stevens adds that the scheme enables him to monitor concordance with medication more effectively, as well. "We're doing a lot better at changing some doses from twice daily to a stronger, once daily dose, for example."

Although the GPs still have to sign the repeat prescriptions, rationalising and synchronising the dispensing of multiple medicines is reducing the overall number of prescriptions that need to be signed, adds Dr Rains.

If patients do not pick up their medication for some reason, the pharmacist will telephone them, but Dr Rains hopes that by switching all medicines to 28-day packs it will be obvious when the next batch is due for collection, avoiding the need to remind people every few weeks.

Pharmacist input to compliance

Those patients who do not have good concordance will also have an opportunity to discuss their medication with the pharmacist when they next pick up their medicines. The pharmacist will ask them how many tablets they have left, and so on.

The idea for the scheme was partly based on the PRISE scheme developed in Coventry (see Medicines Management January/February 2002). The pharmacist is able to make and record interventions and suggestions to changes in the way medicine is dispensed directly on the screen, which the GP also sees.

"The real target will be getting better concordance, and having that regular contact with the pharmacist every 28 days will give us an idea of the reasons for lack of concordance," explains Dr Rains.

Having the pharmacy and practice premise so close is a big advantage, and because the pharmacy is in a rural area, almost all patients the GPs prescribe for also use the same pharmacy. "It is a village pharmacy, and 90 per cent of the patients who come here use the GP surgery, too — it would not be as effective if we were only seeing 5 to 10 per cent of the patients," says Mr Stevens.

This would be more likely to be a limiting factor in busy urban areas, where it is geographically harder for GP practices to have such close links with pharmacies. Nevertheless if the Exeter scheme, and ones like it, are successful there will features that all practices and pharmacies can adopt.

The pilot is due to run for a year, when it will be evaluated. But eventually, Dr Rains says that he sees no reason why most patients on repeat prescriptions should not have their dispensing synchronised in this way.