The Pharmaceutical Care of The Pharmaceutical Care of Patients with Long Term Patients with Long Term

ConditionsConditions

Deirdre WattDeirdre Watt

Team Leader, Community PharmacyTeam Leader, Community Pharmacy

Scottish GovernmentScottish Government

ObjectivesObjectives

• Set out community pharmacy role

• Define concept of pharmaceutical care

• Describe the Chronic Medication Service

• Consider clinical benefits

• Outline timetable for delivery

Community Pharmacy Role

• Developing the role of the pharmacistAddress health inequalitiesMake better use of the workforceMaximise clinical outcomes

• Public Health ServiceServices and informationSmoking cessation clinics, sexual health advice

• Minor Ailment ServiceFree for those who do not pay for prescriptionsOver 600,000 registered – treat or refer

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-adherence2.7% - 6.5% hospital admission due to Adverse

Drug Reaction (ADR)

• Outpatients5% of medicines not added to the GP record

Minor Ailment ServiceMinor Ailment Service

• Over 600,000 patients registered

• 90,000 consultations per month

• Extremely positive patient feedback

MAS Trends

• 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%)

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)

Unscheduled Care PGD usage

Chronic Medication Service Chronic Medication Service (CMS)(CMS)

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

Three Stages

1. Patient registration

2. Pharmaceutical care planning

3. Shared care

CMS Outline• Stage 1

Patient registers with a community pharmacy of their choiceVoluntary – register with one pharmacy onlyUnderpinned by patient consent

• Stage 2Pharmacist assesses patient Pharmacist develops a pharmaceutical care plan

• Stage 3GP issues a serial prescription: 24 or 48 weeksPharmacist dispenses prescription at agreed intervalsFeedback to GP practice – end of care treatment summaryReview or repeat

Improved ConcordanceStage 2: Pharmaceutical care planning

• Patient and pharmacistDiscuss 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

• PharmacistDocuments the issues, desired outcomes and actions in

a pharmaceutical care plan

Monitors and reviews the care plan

Timetable to CMS

• Early adopter testing in FifeDevelop toolkit for implementation8 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

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

New Community Pharmacy Contract Benefits

• Improved accessMedicinesPharmaceutical advice

• Managing demandGP practiceNHS 24A&E

• Addressing health inequalities• Shifting the balance of care