1. Kingsway Medical Practice and Glasgow City HSCP North West Locality
Outcomes of a Pharmacist Led Diabetes Clinic in Primary Care
Sandra Cahill, Sheila Tennant, Dr E Cameron, Dr N Clark, Dr F Kinnon, Dr J Pinkerton, Laura Towler Practice Nurse
Kingsway Medical Practice and Glasgow City HSCP North West Locality
Introduction
This pharmacist led Diabetes Clinic was established in January The emphasis is on delivering patient centred, cost effective, evidence based care in a local setting. This involves shifting the balance of care, managing patients in primary care, who would previously have been referred to secondary care, with the support of secondary care and the wider diabetes community. We will also focus on identifying and addressing barriers to patient engagement.
Aims
To improve HBA1X and Cardiovascular outcomes
Engage patients with a history of poor attendance
Reduce GP practice nurse workload along with reducing secondary care referrals
Focus on patient engagement
Working across interface
Results: Outcomes of Consultations
HBA1C before and after pharmacists intervention where outcome has been measured
Number and type of interventions made by pharmacist prescriber for this sample of patients
Reason for poor engagement
Number of pts
Strategy
Housebound 6
Home visit
Works
Use , text, flexible appointment times
Non English Speaker 9
Use family support Phone using interpreter service
Lack of insight 7
Phone, personal approach
Mental health issues
Repeated invites, phone calls flexible approach
Number of patients
Secondary care referral avoided.
support from 2y care and patient managed in 1y care 16
Patients re enaged after defaulting from 2y care , being discharged from 2y care follow up. Now managed in primary care 5
Patients currently attending 2y care who have been actively managed between appointments 8
Methods
Pharmacist independent prescriber works as part of the GP practice team delivering diabetes reviews . Pharmacist works one day a week in practice
Model of diabetes delivery changed
3 monthly reviews for younger, newly diagnosed, poorly controlled patients.
annual reviews for well controlled.
This facilitates timely follow up and review, appropriate escalation of treatment, stopping ineffective treatment, focus on lifestyle.
Focus on patient engagement. Identify poor engagers through sci diabetes standard reports. Use a personal approach when arranging clinics if standard letters and texts do not work. Flexible appointment arrangements. Focus on what matters to the patient
Managing challenging patients, communicating with secondary care, wider diabetes team, providing care when needed to improve outcomes in primary care e.g. diabetes with multiple co-morbidities, housebound with secondary diabetes.
Results
Retrospective review of a sample of 110 patients with diabetes (current population 312)
Pharmacist has reviewed 71 patients. 39 not reviewed by pharmacist . HBA1C for these patients not seen by pharmacist are all at target
Discussion and Conclusion
Adding a pharmacist prescriber to the General Practice team with a focus on diabetes allowed extra time for patient reviews, facilitating a patient centered, evidence based approach with positive outcomes. Pharmacist led diabetes clinics are now being delivered in 4 practices in the North West of Glasgow.
Particular benefits of the clinic in Kingsway Medical Practice include
Improved patient outcomes
Improved patient engagement, particularly for patients with a history of poor attendance
Increased communication at primary secondary care interface allowing patients to be seen in primary care for longer.
Next Steps
More robust evaluation of the service to allow us to develop a stronger, more sustainable service
Acknowledgements: Thanks to the GPs, practice nurses and all the staff at Kingsway Medical Practice , Kingsway Glasgow for their support
Thanks to the consultants and acute DSNs at Gartnavel General Hospital and the community DSNs for their support
References: Management of hyperglycaemia in T2 Diabetes 2018: A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetics. Diabetologia (2018) 61:
GGC NHS Guideline for the management of Type 2 Diabetes