Medicines
Management
Issue no 6, p8
November/December
2002
|
|
Medicines
Management |
|
Features |
Toolkit to help with single assessment
The NHS Plan proposal for a single assessment process (SAP) for older people across health and social care was re-stated in the National Service Framework for Older People. According to the NSF, implementation of SAPs should have begun in April this year. The NSF says that the assessment does not need to be the sole responsibility of health practitioners, but that social workers involved in the care of older people could also play a part. But how would these individuals, without medical training, identify elderly individuals who might have issues with their medicines, and who would need a more in-depth assessment by a pharmacist? London Pharmacy Services in conjunction with London Region Directorate of Health and Social Care commissioned a research team of three pharmacists and a social scientist, known as the Practice Informants, to explore how the medicines aspect of SAPs could be supported. The team came up with a simple solution: four standard statements that anyone involved in assessing an elderly person's ability to cope with daily life can ask (see Panel). Patients are asked if they agree or disagree with each of the four statements and their answers are graded from "strongly agree" to "strongly disagree". Dr Ruth Goldstein, who is one of the Practice Informant pharmacists, says: "The four [statements] basically cover the issues relevant to medicines and anyone could ask them. If the answer to any of them is "yes" you can then refer the person to an accredited pharmacist." In addition to this initial assessment tool, the Practice Informants reviewed all the medicine assessment tools that have been published to date: "We tried to identify what other people have used and how they have used it," Dr Goldstein says. "[But] we found there was little around that was rigorous and that could be built on. " They then set about devising their own toolkit. She says that the Practice Informants' in-depth assessment tool will assist a suitably qualified pharmacist supporting those patients identified from the four statements as having issues with some of their medicines. The full assessment covers demographics, carers, knowledge about medicine names, patients' access to services, patients' knowledge of dosage regimens, compliance and clinical issues, such as adverse drug reactions. However, the idea is not to "trawl and report" on the whole process relating to a person's medicines management. Dr Goldstein says: "We did a lot of work piloting the tool with elderly carers, GPs and pharmacists. Our approach was to make it practical for everyone — not to be collecting lots of information for the sake of it. It is not worth recording everything if the person is happy with the service and the medicines they are getting." Although the in-depth tool is aimed at assessing the clinical implications of what patients are being prescribed, she says it also addresses management issues, as many medication problems patients are not actually clinical. "Nine out of ten problems are actually to do with coping with the regimen, as most patients are on a reasonably rational medication and, overall, we are doing pretty well at prescribing rationally," Dr Goldstein says. And, because the level of risk can be quantified (from a "minor" level 1 risk to a "potentially fatal" level 5 risk), Dr Goldstein says the tool can help cash-strapped PCTs to prioritise interventions to those with higher risk scores — eg, where the risk score is over 10 for one or more areas. The medication assessment tool was presented at the Primary Care Pharmacy Association conference in Cardiff in September. Dr Goldstein says most delegates knew they ought to be doing it, but few had had involvement with a SAP. She added: "There seemed to be no input from pharmacy, apart from in Chelmsford." Dr Goldstein hopes now that, with the help of these new tools, this will change. She has already heard that some PCTs have begun using an in-depth assessment, some are using the risk assessment and others are using the four statements. She concludes: "The four [statements] are so simple that anyone can use them, and the feedback from them will be enormous and then we will be able to demonstrate the value of pharmacy." The full report, complete with assessment tools and literature review, can be found on the London National Health Service website or via www.pharmacyinthefuture.org.uk |
|
|
Home | Journals | News | Notice-board | Search | Jobs Classifieds | Site
Map | Contact us
©The Pharmaceutical Journal
