PJ Online | MM: Close co-operation over repeat dispensing saves time and money

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Medicines Management
Issue no 5, p6-7
September/October 2002

Features

Close co-operation over repeat dispensing saves time and money

Repeat dispensing schemes of all shapes and sizes are being established. Monika Polak (news and feature writer for PJ Publications) investigates one such scheme in Wales

A repeat dispensing pilot scheme for people taking five or more medicines is demonstrating that community pharmacists can work closely with general practitioners to achieve tangible benefits for all those involved.

According to Chris Martin, pharmacist at St David's Pharmacy Ltd, Pembrokeshire, who runs the scheme, it has reduced medicines wastage and made life more convenient for patients. It has also reduced GP workload and rationalised the work within his pharmacy.

"The patients think it is wonderful as it saves them a journey to the GP," he says. "They are now coming in and saying they don't need certain medicines for the next month. They are getting to the right level of medication and no longer stock piling medicines they do not use at home.

"Not too many patients have had their medication adjusted — it is more a case of tidying-up. For example, if they have a prescription with both coproxamol and paracetamol on it, we ask them which one they are taking. It means that patients only order the drugs they actually use and need, as opposed to the whole range of drugs on the repeat slip.

"As a result there has been a significant change between what is on the repeat slip and what they actually get," Mr Martin says.

Scheme running for nine months

The scheme has been running for about nine months, and currently has some 300 patients registered on it. It was spawned after Mr Martin, as the local community pharmacist and chairman of Pembrokeshire Local Health Group, was asked to attend a meeting with local GPs to discuss more effective ways of tackling prim-ary care workload and improving disease management.

"We were trying to get an overview of what the pharmacists and local health groups could do to help," he says. "It was an ideal opportunity to get medicines management on the go. When we registered people, the pharmacist would give them the overall package."

Who is eligible at the moment?

The scheme involves suitable patients — those taking five or more medicines — being encouraged to register by both practice and pharmacy. If they agree, the pharmacist registers their details, including any allergies and diagnosed conditions, on a pro forma sheet. This information is subsequently fed into the patients' records. Patients also sign the form to allow the pharmacist to order prescriptions on their behalf. The pharmacist then undertakes an initial medication review to identify any contraindications, side effects or other problems that the patient may have with their current medicines.

It also provides an opportunity for the pharmacist to explain the importance of taking medication regularly and, if necessary, advise on healthy lifestyle. The pharmacist then reviews patients every six months at the GP surgery.

All dispensing on 28-day cycle

Mr Martin says: "We align their prescriptions so they come in once a month on a 28-day cycle this helps to reduce wastage associated with repeat prescribing. If patients are not taking their PRN drugs on a 28-day cycle, we ask them why not. It may be, for example, that they have been given enough Senokot tablets to take two at night, but they are only actually taking one. If we recommend any changes, we refer the patient back to their GP and discuss the changes with the GP ourselves."

The St David's pharmacy, which is the only pharmacy in the town, also provides a monitored dosage system for around 40 of its particularly vulnerable patients, who get weekly rather than monthly scripts.

Overall, it deals with about 90 per cent of local prescriptions — some 4,500 to 5,000 items a month, and about a third of these (1,500) are dispensed as part of the repeat dispensing scheme. The 28-day cycle has enabled the pharmacy to spread its workload evenly across the month, having different groups of patients picking up medicines in each of the four weeks.

The pharmacy has now started registering other patients in addition to those on five or more drugs. Predominantly these are people with cardiovascular disease or asthma, together with some on anti-arthritic medication. As long as they are stable on their current regimen, they can be considered for the scheme.

Hard work establishing scheme

Although the scheme is working well, Mr Martin admits it has taken time and hard work to set up, particularly the review process which was the hardest element.

"Thankfully we have phased it in over a long period. It needs to be a phased programme — we were init-ially declining people because it was taking a long time to do the reviews. And you need to be structured. It is useful to have pro forma sheets that patients can take away and fill in themselves," he adds. But Mr Martin is adamant that the service he offers local people is worth the effort. He says: "I have been criticised by some pharmacists for providing this service for nothing, but looking at my standing in the community and with the local GPs, it is worth it. It also helps me as I get more structure in the way that scripts come into the pharmacy.

"I would advocate that the scheme was right for me because it was a plea from local GPs for help. In a local environment it works extremely well.

"But it may need more investment and time to deliver in other areas. I would not advocate it wholesale across the country for everyone, unless there was some formal payment," he adds.

Although the project has not been reviewed yet, the plan is to assess it on an annual basis. However, Mr Martin has no doubt that it has already reaped real rewards for all those involved and for the health service as a whole: "My own feeling is that we have definitely saved money," he concludes.