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New Models of Chemotherapy Delivery

New Models of Chemotherapy Delivery. in a Rural Setting Sandra Melville BOPA October 2007. The “Oban” Model. Based at Lorn & Island Hospital in Oban Visiting oncologist from Beatson Oncology Centre Patients able to receive treatment locally

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New Models of Chemotherapy Delivery

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  1. New Models of Chemotherapy Delivery in a Rural Setting Sandra Melville BOPA October 2007

  2. The “Oban” Model • Based at Lorn & Island Hospital in Oban • Visiting oncologist from Beatson Oncology Centre • Patients able to receive treatment locally • Cut down need/frequency of travel • 200 mile round trip

  3. Where’s Oban?

  4. Why provide a service there? • Scottish Government Publication: Delivering for Health:“Service models that are effective in urban areas may be unsuitable in such locations.” • Cancer redesign meetings - “except Oban” • Long journeys to Glasgow – emesis!

  5. Why provide a service in Oban? • Patient demand (they don’t like • being sick!) • “Each Rural General Hospital should examine what level of elective service it can safely support” (Delivering for Health) • Provide a safe service as locally as possible (Not vice versa!)

  6. But…. • Oncologist visits fortnightly • Most chemo given weekly or • 3weekly • Noticed this wasn’t handy! • Pharmacist Prescribing

  7. So how does it work? • Nurse/pharmacist led service • Supported by visiting oncologist and 24/7 consultant physician cover • Pharmacist prescribes • Patients get treatment locally • Care often shared with Beatson Oncology Centre, Glasgow

  8. Small teams – sustainability Communication with visiting oncologist Geography! What are the threats/challenges ?

  9. Rural Setting • Gateway to the Isles • Serves large rural population • 17 % of population live on islands • Coastline of Argyll is longer than that of France

  10. What this means for patients… • 26 inhabited islands: • Limited access to health services • Some have no resident GP • Only one has a community pharmacy!

  11. Re-admission to hospital can be challenging

  12. Especially in the winter……

  13. How did Supplementary Pharmacist Prescribing Improve Patient Care? • Clinical Management Plans – increased contact with pharmacist • Enhanced continuity of care • Improved access to advice, medicines information and supplies • Speedier discharge from hospital, reduced number of overnight stays – limited ferry services

  14. Optimising Care • Good communication with oncologist • Increased contact between prescriber & patient • Doses tailored to suit individual needs • Close working relationship with chemotherapy nurse specialists • Toxicities minimised – particularly important for patients travelling back to remote islands.

  15. Services in other Rural Areas • Orkney – population 21,000, 16 inhabited islands • Peripheral cancer unit co-ordinated from Aberdeen • Nurse/pharmacist led Capecitabine clinic • 4/5 hour car journey from Aberdeen, + 1 hour ferry crossing • OR 1 hour flight!

  16. Thank You

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