Managing medicines the patient's way
| Helping patients to get the best
from their medicines is a laudable target. But how do health care
professionals know what patients actually want from their treatments
and the problems they themselves perceive? Naomi Kempner reports |
Naomi Kempner is a freelance
writer
|
MMS Collaborative Project Facilitator Pauline Lansdale
explains how her primary care trust has tapped into a useful source
of patient opinion — the
local “Patient Voice”. She hopes to make her collaborative
a patient
focused one, rather than “imposing plans we thought best for them”.
Patient Voice has emerged as part of PCTs’ strategies
to embrace the NHS plan. Quite literally, the scheme allows patients
to voice their
opinions on health matters and helps the PCT to make informed decisions.
Ms Lansdale’s PCT, Castle Point and Rochford, in Essex, has a very
active group, with around 130 members— all local people who have
chosen to become involved in local health issues.
Castle Point and Rochford PCT
Castle Point and Rochford PCT serves a population
of 170,000 in a largely semi-rural area. It has 27 GP practices — a
mixture of large group practices, single-handed surgeries and
smaller groups.
There are 32 pharmacies. Hospital services to the area are provided
mainly by Southend Healthcare trust and Basildon University hospital.
The PCT is in the second wave of the medicines management collaborative.
Its work so far has involved patient review, particularly of the
elderly and care
home residents, reduction of “as directed” instructions on prescriptions
and improved script synchronisation. It is also attempting to reduce quantities
of wasted medicines, as a recent audit carried out by community pharmacists
in the PCT suggested that at least half a million pounds worth of medication
is wasted annually.
The medicines management collaborative is a small team including project facilitator
Pauline Lansdale (who has a background in health informatics), Simon Williams,
the prescribing adviser and Stephanie Andrews, prescribing support pharmacist. |
Around 15 members attend
meetings on a regular basis. The group holds workshops and training programmes
in which patients can find out about
the work of the PCT and give opinions, comments and ideas. Members can
also learn more about the NHS in general and about what the Department
of Health is doing on a national level in England to encourage patient
and public involvement. Other members of the trust’s Patient Voice
have a less active role. They receive newsletters and are occasionally
invited to answer questionnaires. Improve use and reduce waste
Pauline Lansdale is using her trust’s Patient Voice
to find out the problems patients have with medicines in a bid to improve
their use
and reduce waste.
An initial survey of the group has confirmed some widely held beliefs
but also flagged up new issues.
Responses from 100 patients showed that a majority of those
involved were elderly, reflecting users of local services. Many were
unhappy about how long it took to get a prescription. In some cases,
patients were waiting up to three days for repeat prescriptions.
Wider social needs
Another bugbear was that pharmacists might not have all
the patient’s
medicines in stock. This was not a problem for some, but if an elderly
person needed transport to the shops, a
return visit became difficult. Some medicines problems related to wider
social needs such as difficulty in climbing the steps onto buses to go
to the pharmacy.
Although all our pharmacies offer collection and delivery, many patients
remain unaware of these services. We need to improve communication here,” Pauline
adds, suggesting use of surgery posters inviting patients to have their
prescriptions picked up and delivered.
Many old compliance chestnuts have also reared their heads in the survey.
Patients cannot read labels, they cannot remove lids, labels are stuck
over instructions, labels are stuck over foils so patients cannot press
tablets out.
In addition, many patients cannot remember what medicine to take and
when. Pauline says that “as directed” labels are being phased
out of the whole PCT, to help avoid this
scenario.
“Patients tend to accept the system rather than complaining. They don’t
want to get people into trouble, particularly where their doctor is involved,” Ms
Lansdale comments.
She is now evaluating the results of the survey, which she hopes to feedback
to primary care staff. She will also be using elements of the survey
for future medicines management
initiatives.
Making the most of patients
Patients need to be listened to
|
Ms Lansdale is further using the
enthusiastic core of Patient Voice members by including four on the collaborative’s
recently formed steering group. She hopes that after attending and contributing
to her meetings, the patients will report back to their own Patient Voice
group and to their newsletter.
She also envisages this small group of patients helping her to give talks
and presentations on medicines issues to the public.
“Patient involvement is now a big issue in the NHS. I am sure that every
medicines management team now has this on their agenda. We are lucky
to be able to draw on our active patient involvement fostered by our
communications department at the trust and what was the community health
council,” Pauline says.
|
