1. Victoria Gemmell1 Professor Alex Mullen2.
“What healthcare improvements can be made by introducing clinical pharmacist review to Care At Home patients?”
Victoria Gemmell1 Professor Alex Mullen2
1 Prescribing Team, NHS Lanarkshire, 2 Strathclyde Institute of Biomedical Sciences, University of Strathclyde, Glasgow
Background
In 2016, the Scottish Government legislated to merge health and social care into a single, integrated system.1 These plans included shifting of resources to the newly created Integration Authorities to ensure more care could be provided in homely settings and a greater focus on preventative strategies to reduce hospital admissions. 2 The need for change in the way services were delivered and the requirement to utilise the skill of other professions, including pharmacists, had already been identified, with plans underway to ensure these new services were high quality and were also cost efficient and sustainable.3,4.
National strategy document “Achieving Excellence” specifically identified that pharmaceutical care of patients receiving care at home (CAH) required improvement, with a focus on reducing polypharmacy and rationalising medicines but also including pharmacy involvement in reablement and single shared assessment.5
Aim
Results
To investigate the potential clinical, social and economic benefits that could be generated by introducing clinical pharmacist review to patients receiving a Care at Home (CAH) service provided by local Social Work (SW) teams.
Data collection identified 3 areas where pharmacist intervention could provide benefit and improve patient outcomes:
*Service Alignment *Medicines Review *Patient safety
Methods
The pilot, qualitative project setting was a GP practice within Primary Care, NHS Lanarkshire with a patient population of approximately 13,000. Practice patients receiving a CAH service were identified by SW (n=35), exclusion criteria applied and then a final sample (n=32) underwent a Polypharmacy Plus review by a clinical pharmacist (as described in figure 1) who had knowledge of the current social care provision
35.2% of prescribed medicines were recognised as requiring review
22 Discrepancies in service provision were discovered
20 Patient safety issues were identified
Polypharmacy review
7 Steps Model6
Identify aims and objectives of drug therapy
Identify essential drug therapy
Remove unnecessary therapy
Ensure therapeutic objectives are being achieved
Identify patient safety risk
Is therapy cost effective
Is patient willing and able to take therapy
Review Timing of Medicines
Cross -refer to Care at Home provision. Reduce number of doses per day and align medicine times of administration where practical
Meet with GP
Discuss potential changes and implications with patient's GP
Meet with CAH Team Lead
Discuss suggestions to alter medication times and explore potential for change to care provision
7 Steps Model
Potential Efficiencies of £ per patient or £3 MILLION across North Lanarkshire
Conclusion
This project has shown that addition of a clinical pharmacist to the care provided to CAH patients has the potential to reduce the number of prescribed medicines, improve patient safety and also to help SW services review care provision with a view to creating released capacity.
Figure 1. Patient Review Process.
References 1. Health and Social Care Delivery Plan. December Accessed June 2018, 2. 6 Essential Actions to Improving Unscheduled care Accessed June 2018, 3. National Clinical Strategy for Scotland. Scottish Government Accessed June 2018, 4. The 2018 General Medical Services Contract in Scotland. November 2017.Accessed June 2018, 5. Scottish Government: Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland. Accessed June Polypharmacy Guidelines. Scottish Government 2017