Services in community pharmacy
| Now that the Community Pharmacy
Medicines Management Project is up and running, Helen Rhodes, describes
progress to date |
Helen Rhodes is the project
manager
|
Medicines management is high on everyone’s
agenda. In England, PCTs are working towards the target of having a
range of medicines management
schemes in place by April 2004, and pharmacists are developing local
partnerships to improve the health of people in their communities.
The Community Pharmacy Medicines Management Project (CPMMP) supports
the themes of helping patients get the best from their medicines and
making better use of pharmacists’ skills — both of which
are detailed in the Pharmacy in the Future document (DoH, September 2000).
Since then, A Vision
for Pharmacy in the New NHS (DoH, July 2003) has
been published and it identifies the ten roles that underpin the future
direction of pharmacy services and their wider role in England.
Medicines management features throughout the vision document, particularly
in the provision of services for people with enduring illness. Other
ways of optimising the use of medicines are also featured, for example,
advising patients and other health professionals on the safe and effective
use of medicines.
Against this background an increasing number of community pharmacists
are becoming involved in medicines management schemes.
The study
The CPMMP (in contrast to the collaborative approach being taken by the
National Prescribing Centre’s scheme) is taking a research approach
to test the service rigorously and provide much needed evidence for
further development. The aim of the project is to evaluate medicines
management by community pharmacists for patients with a confirmed diagnosis
of coronary heart disease. The CPMMP began in October 2001 with the
purpose first to test the feasibility of introducing an intervention
process into the relationship between community pharmacist, patient
and GP and, second, to evaluate the extent to which the aim of the
process has been achieved. The project involves community pharmacists
engaging with their patients and with their primary care colleagues
to deliver measurable health gain for the patient — something
that we know to be happening already. Until this project, only disease-specific
individual components of a medicines management service have been evaluated
to provide an evidence base.
Medicines management services from community pharmacy can
deliver significant benefits. The panel (below) lists those that were
proposed at the
launch of the project in 2001 and that would benefit patients and GPs.
Benefits for patients
• Community pharmacy-based so more accessible
• Services can be targeted at the chronically ill
• Improve patients understanding of medicines
• Improve confidence and compliance
• Reduce or eliminate adverse drug reactions and side-effects
Benefits for GPs
• Integration of care from pharmacists and GPs
• Medicines information provided by pharmacists
• Fewer problems for GPs
• More time for GPs to spend on other aspects of patient care |
There are nine pilot areas, 65 trained pharmacists and 44 general practices
involved in the project. The areas are geographically scattered and were carefully
selected from a large number of bids taking into account factors such as socio-economics,
prevalence of CHD, support from the PCO and previous experience in collaborative
working.
The study is a randomised controlled trial — the largest study of its
kind in community pharmacy in England. The University of Aberdeen is leading
the evaluation together with the universities of Keele and Nottingham, and
the College of Pharmacy Practice is evaluating the training.
The second panel (below) shows the aim of the intervention
process. The full version of the trial summary, including the study design,
can
be found on the project
web-site (see Further information p7).
Aim of the intervention process
• To deliver measurable health gain to
the patient
• To deliver improvements to value for money in medicines prescribing
and cost reductions for the NHS
• To construct a new approach to patient care by extending the partnership
between pharmacist, patient and physician
• To facilitate collaboration between the health professionals in primary
care
• To maximise the use of the skills and training of the community pharmacist
|
The project
I became involved in the project in October 2001 when I was appointed
local project co-ordinator to the North Tyneside pilot area, along
with a further seven co-ordinators who covered the remaining eight
pilot areas. I went on to become National Project Manager and, since
then, I have been involved in the project full time.
Whenever possible, I take the opportunity to emphasise that this is a
study of the feasibility of the service and, as such, the eventual service
will benefit from the findings of this study. While progress is being
made, we are able to find practical solutions to the problems that are
encountered along the way and this will eventually make for a much more
robust service offering.
The project is now in its final stages. Having begun in October 2001,
upwards of 700 patients have since been seen by trained pharmacists in
their community pharmacies.
Study design
The study design allows for a 12-month intervention period running from
when each patient is first seen in the pharmacy. Data held in the patients’ medical
records at the GP practice are collected at the start and end of the
12-month intervention period to allow an assessment of any change in
treatment to be made. This is for both intervention and control patients.
In addition, questionnaires and focus groups are being conducted to
investigate the experiences and attitudes of patients as well as pharmacists,
GPs and practice staff. This will assist the research team in developing
recommendations that can be made about the implementation of this kind
of service. The results are due at the end of July 2004 and, as the
minister, Rosie Winterton, said at the recent BPC conference in Harrogate,
the results are awaited with great interest. Along with other pieces
of work, the results of this project will be highly informative when
considering how this type of medicines management service can be delivered
within the context of the new contract. Without doubt, there are great
opportunities for community pharmacists to make the most use of their
skills and to continue to develop patient-centred services that are
appropriate to the needs of their local population.
Further information
• www.medicinesmanagement.org.uk
The site includes details of the trial summary, articles on clinical
governance and patient confidentiality and, in future, articles on meeting
local health needs and patient benefits.
• The CPMM resource pack can also be downloaded from the web-site.
It is aimed at community pharmacists/PCTs who are interested in delivering/commissioning
a medicines management service from a community-pharmacy setting.
• Frequently Asked Questions. These are essential reading for any community
pharmacist new to medicines management.
• Helen Rhodes, project manager, can be contacted by tel: 0191 2516064;
mobile: 07789 201022; e-mail: helen.rhodes@psnc.org.uk
• Comments can also be sent to info@medicinesmanagement.org.uk
This project is funded by the DoH and is a joint initiative between the
PSNC, the National Pharmaceutical Association, the Royal Pharmaceutical
Society of Great Britain, the Company Chemists Association and the Co-operative
Pharmacy Technical Panel. |
