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Taking medicines review into a mosque

Compared with the indigenous population in Britain, ethnic minoritygroups, and South Asians in particular, are more likely to develop type2 diabetes, to develop it earlier and to present with complications.Glasgow has the highest ethnic minority population in Scotland and alarge South Asian population, many of whom have diabetes. But knowledgeof diabetes and its complications among South Asians is poor and, inmany sectors of the health service, these patients have lower levelsof attendance at clinics than other groups.

“We have figures for attendance levels for South Asians at pharmacist medicationreview clinics of less than 50 per cent compared with greater than 80 per centfor the indigenous population,” says Alia Gilani, prescribing support pharmacistfor Greater Glasgow Primary Care Division. Together with Richard Lowrie, leadclinical pharmacist for the Greater Glasgow Primary Care Division, Miss Gilanidecided that increasing access to health care services would be key to improvingthe health of these patients.

Glasgow Central Mosque

Glasgow has the largest Muslim population in Scotland. “We decidedthat the best way to improve access to health care services would beto hold them in a place Muslims visit frequently,” Miss Gilanisays. Glasgow Central Mosque is the largest mosque in Scotland and, sinceprayer is one of the five pillars of Islam, has three to four thousandvisitors every week. Within the mosque is an elderly day care centre,which, Miss Gilani believed, offered an ideal location for a servicesupporting the care of patients with chronic conditions.

“I spoke to an Asian GP I had worked with before, who was also thegeneral secretary for the mosque, about our idea. He arranged a meetingwiththe manager of the mosque’s elderly day care centre, who was veryreceptive,” she says. Miss Gilani and Mr Lowrie therefore decidedto hold a medication review clinic for elderly patients at the centre.

Most of the patients who go to the day care centre speak either Urduor Punjabi. Since Miss Gilani speaks Urdu and understands Punjabi, sheis able to talk to the patients about their medication, helping to overcomesome of the cultural and communication barriers that might prevent somehealth care professionals from understanding these patients’ healthand social care needs.

The clinics are run once a week for two hours. Each patient receivesa basic medication review, along with health promotion advice, bloodpressure measurement and blood glucose monitoring. Written consent isthen obtained from the patient in order to access case notes. Miss Gilaniinforms the patient’s GP by letter of the service provided.

Once a convenient time has been arranged for Miss Gilani to access therecords, a more thorough, paper-based medication review is carried outwith the patient at his or her GP’s surgery. Clinical recommendationsare made to the GP on a referral form and, once these have been agreedwith the GP, Miss Gilani prints out a new prescription and organisesany necessary blood tests with the practice nurse. She then meets thepatient again at the mosque in order to pass on the prescription andexplain any changes made to the medication. This is done verbally ifthe patient is unable to read.

“Then, if necessary, the patient is referred on to the multidisciplinaryteam, for instance, to secondary care, a multi-cultural counsellor, adietitian or a podiatrist. The patient returns for follow-up monitoringvisits at the mosque until target drug doses and levels are achievedfor blood pressure and cholesterol, all tests necessary have been doneand there are no clinical issues left,” Miss Gilani explains.

Progress

Since the project began in July last year, Miss Gilani has seen fouror five patients each week. “Most of the success of the projecthas been down to a combination of successful communication and trust,which has built up over three years of working in surgeries,” MissGilani says.

A total of 58 patients have had medication reviews, 54 of whom haveconsented to onward referral for a full review with pharmacist accessto theirmedical records. GPs and nurses have referred patients to the clinicand there have been a number of self-referrals from patients who havefound out about the service from friends and relatives and have cometo the mosque specifically asking to see Miss Gilani.

The patients seen at the mosque generally require several reviews andcontinuous follow up. The clinic currently has a waiting list of around13 patients, but this is increasing as the popularity of the servicegrows within the community.

Next steps

Miss Gilani and Mr Lowrie have recently managed to secure extra fundingfrom the Scottish Executive for the project and have added a communitypharmacist to their team, who is able to offer additional support oneday a week.

“The extra pharmacist has taken over one of my practices, allowingme to use that time to start clinics in a new surgery, and so see morepatients,and pilot a project in which a community pharmacist refers South Asianpatients with chronic conditions to us,” Miss Gilani says. “Thepatients are identified when they hand in their prescriptions and theysign a consent form allowing me to access their case-notes. I then conducta medication review at the practice and arrange to carry out a reviewat the pharmacy supported by the community pharmacist,” she adds.

Miss Gilani and Mr Lowrie are keen to expand the project. “Thereare many other groups with health inequalities who could benefit enormouslyfrom being able to talk about their medicines to a pharmacist who understandstheir culture and speaks their language,” she says. “So farI have been contacted by three more organisations which have heard ofthe service running at Central Mosque and would like the same at theirorganisations.” Miss Gilani hopes that these other groups, basedin a voluntary community centre, an elderly day care centre funded bysocial work and a Muslim women’s education centre, can benefitin a similar way to the patients using this mosque-based clinic.

Citation: The Pharmaceutical Journal URI: 10018070

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