CPPE helps pharmacists incorporate concordance into everyday practice
Over 3,000 pharmacists have taken part in a concordance
programme introduced by the Centre for Pharmacy Postgraduate Education
earlier this year to
get concordance into pharmacists’ everyday practice.
Matthew Shaw, assistant director CPPE, manages the concordance project.
He explains: “The programme was developed following a series of
focus groups attended by those pharmacists involved in setting up local
pharmaceutical services pilots. One of the issues identified during the
meetings was that pharmacists need to learn to support patients when
entering into partnerships with them.”
Designed to meet different learning preferences, the programme, now primarily
available as an open learning package, was initially made available as
a national workshop and as open learning material. Mr Shaw comments: “Concordance
is important enough to all pharmacists for it to be run as a national
topic.” Over 100 workshops, delivering the same learning outcomes
as the open learning material, were held throughout England from January
to March and were attended by 2,411 pharmacists overall. The open learning
package has so far been completed by 691 pharmacists.
Four booklets
The programme consists of four booklets, each with a different
purpose. The first booklet, “Foundation learning” sets the background
and context of concordance and emphasises why it is important. It explains
the difference between compliance and concordance, encourages pharmacists
to reflect on their personal viewpoint of patient partnerships and
suggests that if pharmacists engage in concordance with over-the-counter
transactions, then why not do so with prescriptions? The booklet also
introduces the Expert Patient Programme.
The second booklet introduces a four-stage CPPE concordance model — share,
explore, negotiate and agree. It contains a worked example of a structured
patient interview, based around partnership working.
The third booklet, “Telling tales”, makes use of a video
with real life cases to demonstrate the way that concordance can work
in practice.
The fourth booklet, “Putting it into practice”, includes
a series of evaluation tools and audits, with a challenge for pharmacists
to try out what they have learnt with a couple of patients, and to see
how concordance can work for, and benefit, them. Has it influenced practice?
So how has the programme influenced everyday practice?
Mr Shaw says that during feedback from the workshop sessions, pharmacists
reported that
the programme had given them an insight into what concordance really
is and how it can be put into practice with patients. Pharmacists commented
that it made them more aware of concordance issues. He says: “Specific
comments included plans to revise the way in which medication review
clinics were undertaken to put concordance into practice.”
Steven Brill, proprietor of Falconers Chemist, St Albans, Hertfordshire,
and chairman of Hertfordshire Local Pharmaceutical Committee, has attended
a CPPE concordance workshop. He says that it reinforced what he considers
to be good practice. “I have always taken the approach of talking
to my customers about what they want and satisfying their needs rather
than saying ‘this is what you need’.” He says that
the programme has helped him to carry through concordance into his dispensing
work as well as practising it during over-the-counter prescribing.
Sheelan Shah, community pharmacist, Lex Pharmacy, Cheshunt, Hertfordshire,
has also attended a workshop. He reported back some of the issues of
concordance that he had learnt from the sessions to GPs at a local GP
practice meeting. He emphasised the point that, if patients know what
they are taking their medicines for (by putting the indication on the
label), then they are more likely to take them. He has since observed
an increase in the amount of informed advice GPs have been putting on
prescriptions, in terms of the dosage and what the medicine is for. “A
lot of ‘as directed’ has been removed,” he says. This
work is also being done as part of the medicines management collaborative,
in association with his primary care trust.
Mr Shah adds that as a result of the programme, he now gives patients
treatment options for OTC medicines. “That is a major impact of
the course,” he says. He also says that since attending the workshop,
he has trained his dispenser on the topic of concordance.
Gill Dorer, professional development manager, Medicines Partnership,
has observed a workshop. She says that she “found it to be excellent,
bringing community pharmacists up to speed with the concept of shared
decision-making in prescribing”. Although she highly rates the
open learning package, in her view, a live course is a better option
for learning. The workshop enable participants to work with colleagues,
a tutor and an expert patient as well as participating in role play within
a group. Participants are also given the opportunity to practise concordant
consultation skills.
Commenting on the outcomes of the programme, Mrs Dorer says she hopes
it will focus the minds of community pharmacists to spend time having
conversations with patients. It will also help pharmacists work in partnership
with patients while respecting their rights and enabling them to make
an informed choice as to whether or not they take a medicine. More counselling
CPPE tutor for Bromley, John Hewitt, visits pharmacies
in his role as secretary of Bexley, Bromley and Greenwich LPC. He says
that since
the CPPE workshop was rolled out, he has seen more pharmacists spend
that moment longer counselling patients than they had done previously.
He adds that they are also doing so “in a reactive way rather
than a proactive way”.
Karen Rosenbloom, CPPE tutor for East London, has run a workshop. She
comments that a lot of pharmacists in Hertfordshire are now up to speed
with concordance. “I think that when you now say the word ‘concordance’,
people know what you are talking about.” She adds that she is trying
to introduce the concept of concordance into shared care protocols at
a strategic level as a consequence of the CPPE programme. One area she
is concentrating this on is the supervision of methadone consumption.
Following the success of the programme, Mr Shaw and Mrs Dorer have held
preliminary discussions with the Primary Care Pharmacists Association
and the National Health Service University with a view to developing
a concordance multidisciplinary resource to be rolled out through the
NHSU to PCTs.
The open learning package can be ordered via the CPPE website,
by contacting the CPPE on 0161 7784024 or by using the paper based system
in the CPPE brochure (sent out three times a year). |
