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The Pharmaceutical Care of Patients with Long Term Conditions

The Pharmaceutical Care of Patients with Long Term Conditions. Deirdre Watt Team Leader, Community Pharmacy Scottish Government. Objectives. Set out community pharmacy role Define concept of pharmaceutical care Describe the Chronic Medication Service Consider clinical benefits

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The Pharmaceutical Care of Patients with Long Term Conditions

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  1. The Pharmaceutical Care of Patients with Long Term Conditions Deirdre Watt Team Leader, Community Pharmacy Scottish Government

  2. Objectives • Set out community pharmacy role • Define concept of pharmaceutical care • Describe the Chronic Medication Service • Consider clinical benefits • Outline timetable for delivery

  3. Community Pharmacy Role • Developing the role of the pharmacist Address health inequalities Make better use of the workforce Maximise clinical outcomes • Public Health Service Services and information Smoking cessation clinics, sexual health advice • Minor Ailment Service Free for those who do not pay for prescriptions Over 600,000 registered – treat or refer

  4. The Patient Journey • Patient has GP appointment • Prescription taken to pharmacy At least 5.2% of items not dispensed • Patient takes medication 30-50% non-adherence 2.7% - 6.5% hospital admission due to Adverse Drug Reaction (ADR) • Outpatients 5% of medicines not added to the GP record

  5. Minor Ailment Service • Over 600,000 patients registered • 90,000 consultations per month • Extremely positive patient feedback

  6. Registration Over 60 - 40% Under 16 - 33% Income related - 19% Maternity / HBE - 7% 16-18 (education) - 1% Prescribing Paracetamol (18%) Ibuprofen (7%) Chloramphenicol (5%) Malathion (4%) Clotrimazole (4%) MAS Trends

  7. Unscheduled Care PGD • Provision of medicines under a national Patient Group Direction (PGD) when a GP is unavailable • Pharmacist can give up to one prescribing cycle of a patient’s medicines • PGD covers all medicines in the British National Formulary (BNF) – with exceptions detailed (e.g. controlled drug, hospital only treatments)

  8. Unscheduled Care PGD usage

  9. Description Personalised pharmaceutical care for patients with long term medical conditions. Purpose Maximise clinical outcomes for patients Minimise predictable undesirable effects Increase patient understanding of their medicine – increase compliance, reduce waste Chronic Medication Service (CMS)

  10. Three Stages

  11. CMS Outline • Stage 1 Patient registers with a community pharmacy of their choice Voluntary – register with one pharmacy only Underpinned by patient consent • Stage 2 Pharmacist assesses patient Pharmacist develops a pharmaceutical care plan • Stage 3 GP issues a serial prescription: 24 or 48 weeks Pharmacist dispenses prescription at agreed intervals Feedback to GP practice – end of care treatment summary Review or repeat

  12. Patient and pharmacist Discuss and assess the patient’s condition/s, medicine/s and general health Identify any issues / problems Establish desired outcomes Agree any actions to address them Pharmacist Documents the issues, desired outcomes and actions in a pharmaceutical care plan Monitors and reviews the care plan Improved ConcordanceStage 2: Pharmaceutical care planning

  13. Timetable to CMS • Early adopter testing in Fife Develop toolkit for implementation 8 week consolidated end to end testing • Registration • Serial prescription • End of care treatment summary • Roll out from October • Full CMS for patients with exemptions • Complete roll out to all – April 2011

  14. Summary – CMS Benefits • Improved clinical outcomes • Improved concordance • Reduced wastage • Easier patient journey • Promotion of self care • Better utilisation of the workforce • Encourage team working

  15. New Community Pharmacy Contract Benefits • Improved access Medicines Pharmaceutical advice • Managing demand GP practice NHS 24 A&E • Addressing health inequalities • Shifting the balance of care

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