Presentation on theme: "1 City Country Medslink Presented by: Deirdre Criddle Hospital Liaison Pharmacist D Criddle, P Jayasuriya, R Clifford, J Benzie, K Crouchley and J Lack."— Presentation transcript:
1 City Country Medslink Presented by: Deirdre Criddle Hospital Liaison Pharmacist D Criddle, P Jayasuriya, R Clifford, J Benzie, K Crouchley and J Lack Thinking Country in the City
2 July, 2002 Once upon a time there was a vision…..
3 Why do CCML? National review of hospital initiated HMR pathways underway Opportunity to inform future framework and highlight unique difficulties faced by country patients Well documented intervention to improve medication safety and reinforce hospital advice in the home Country patients requiring tertiary hospital treatment are often sicker than their urban counterparts GMML ideally placed
4 Project aims 1.Identify rural patients at high risk of medication misadventure admitted to a tertiary teaching hospital. 2.Facilitate communication and liaison between rural primary healthcare providers and an acute care tertiary hospital – especially with respect to medication management and resolving medication related problems. 3.Explore the facilitators and barriers to a framework providing early access to HMR in the early post discharge period.
5 CCML Pilot Project Partners in post discharge care The research proposal The ethics approval The MoU
6 CCML tools and forms Recruiting the team Risk stratification tool, flowchart Referral form Patient information and consent form
7 STAGE 1 Patient identification: Patient admitted to SCGH from Goldfields Midwest region HLP screens for medication misadventure and requests consent HLP phones GP and Community Pharmacist. Gains consent, sends forms and enrols patient GP returns: Consent & HMR referral and patient’s latest medication list HLP sends referral, DC Summary, NIMC and latest med list from GP to rural accredited pharmacist. STAGE 2 Rural accredited pharmacist coordinates: Date and venue for Home Medicines Review (HMR) interview. Conducts HMR and resolves urgent medication related problems at visit or within 24 hrs. STAGE 3 Rural accredited pharmacist provides: Report to GP and HLP/Researcher. Data collection information from HMR to HLP within 7 days of HMR visit.
8 The patient stories … ‘data with a soul’ From a remote community to SCGH via Newman “They told me I was going to Geraldton. They said they would ‘fix’ my leg, so I thought, OK – it will be worth the hassle.” “But their idea of rehab is 10 minutes with a physio and the rest of the time, I am stuck here, looking out the window, sitting on this bed.” Lonely, isolated, displaced
9 Patient stories …a carer’s plea “A** was meant to be discharged tomorrow, but they had no idea how I was meant to get back to Dongara.” “They expected me to drive 6 hours with my physically handicapped husband, who is still unwell, and is no where near rehabilitated yet.” “I wont let them compromise on his care. I can and will fight for him. “Heaven help those patients who are too frightened to ask. They just get shoved out the door to free up a bed for the next patient.”
10 Results 60 patients screened for eligibility 18 of the eligible consented 16 referred for HMR 2 for Medscheck Reasons for admission Cardiovascular, GI, falls and systemic infections, Average age 65 years (35-91) Locations Geraldton Dongara Meekatharra Kalgoorlie
11 Results: The Good 60 patients screened using validated tool 27 patients interviewed. 8 patients received an HMR (7 within 10 days of discharge) 2 patients received a “Medscheck” (within 1 month) 2 HMRs Goldfields / 6 HMRs Midwest Increased awareness of country patients on wards Increased awareness (and engagement) of service in Goldfields Excellent awareness in the Midwest Knowing the “players” helped build trust
12 Results: The Bad 1 HMR was provided very much later (months post discharge) due to lack of referral Exposed several gaps in care for country patients 42/60 (70%) patients screened from the Goldfields Midwest region were considered to be at high risk of medication misadventure 17 patients High Risk – ineligible Post stroke/trauma/dementia (7) Declined (3) “Staying in the city” (6) Renal/Chemo/Liver
13 Results: The very, very sad… 2 GPs did not send the referral ~ despite several requests (1 patient newly commenced on warfarin) Muted “halt” to HMR program in February 2013 resulted in a Change to Business Rules ~ 4 identified, consented and eligible patients were unable to access an HMR post discharge Goldfields Outreach HMR service – delivering HMR to rural and remote communities, which was “just beginning” has been shelved
14 What they thought “It was excellent seamless continuity of care, which the patient found very reassuring and prompted the appropriate medication changes required without delay”. Dr James Quirke, GP, Geraldton “Was a great idea but more difficult to institute than we thought. Was a positive experience for the patients on all accounts, namely the experience with Deirdre and the follow up with us and their GP”. Ross McKay, Community Pharmacist, Geraldton “The CCML project impact on patient care was similar to the impact of the invention of the toasted sandwich maker on starving uni student’s diets”. Patrick Bettridge, Chief Hospital Pharmacist, Geraldton Regional Hospital
15 What they thought “It was really “top drawer” service. The pharmacist came to my home, and spent a good deal of time explaining my tablets.” “I had never had that before. She didn’t hurry me – and at the end, I really understood why I had been put on all these extra tablets and how important it was to keep taking them.” Mr QS ~ CCML Patient, post AMI; Kalgoorlie
16 Lessons from CCML Patient’s first – know them, and their journey Put “Country” thinking into City hospitals “Good clinical handover” on discharge “Find and map the gaps” ~ fund research and local solutions Improve access to medication review services in regional and remote communities Implement strategies proven to work across transitions of care Essential ingredients for a collaboration equation: Research engaging Medicare Locals, Hospitals, Primary Care Providers & Patients