Prescribing & Medicines Management
Issue no 3, p1
May/June 2003

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Scotland agrees frameworks for pharmaceutical care

Community pharmacists in Scotland are to begin developing model schemes for pharmaceutical care for palliative care patients and the frail elderly, following the publication of steps frameworks for each condition.

Annamarie McGregor, project director for the joint initiative between the Scottish Executive and the Royal Pharmaceutical Society in Scotland, said the framework was intended to be implemented locally, and adapted as necessary by each primary care trust that had suitable schemes.

Each framework describes the components, audits, assessment tools and training recommendations necessary for model schemes to take off. Ms McGregor said the frameworks provided a template that could be adapted by PCTs locally, as other schemes for chronic conditions were developed.

Step one is about preparing practice, and involves looking at improving access to medicines, compliance assessment, integrating care through discharge planning, and improving communications and teamwork.

Step two is more complex, and involves pharmacists carrying out targeted interventions to identify patients' needs, and the final step is a holistic medication review, covering all of the patient's drug therapy, as well as aspects of health promotion.

Each framework details the policy context, background and clinical evidence for suggested actions. Under each step are a range of standards, along with the rationale, essential criteria that practices must meet and information requirements.

Ms McGregor said that the most important aspect of the framework was that pharmacists began to make connections locally with other health professionals using the steps framework.

"Adapt it and adopt it is the message. We know it works and that it will make a difference to patient care but, for example, pharmacists need to find out who their local public health doctors who lead on falls prevention are, as well as social care staff. It's about much more than pharmacists simply saying this is a wonderful idea."

Ms McGregor hoped PCTs would adapt the steps framework as a template for involving pharmacists in other pharmaceutical care schemes to improve medicines use in a range of chronic conditions, including diabetes and epilepsy. She added that a national training package was being planned for pharmacists who wanted to progress through all the steps and that it would, perhaps, take two years for them to get to step three.

Five PCTs in Scotland are already doing medication review clinics, and the pharmacists from each of these have so far had about five days' training, which Ms McGregor said should be sufficient.

"We hope that by the time they have spent a year or so doing compliance assessments, the whole idea of phoning the doctor and saying 'I'm worried about a particular patient' will be less daunting. By next year we will have many more pharmacists involved in suggesting targeted interventions in a simple way."