Care of the elderly - an osteoporosis medication management clinic
Developing appropriate services that consider patient pathways and offer integrated care to enhance quality of life for the elderly population in the UK is recommended in the National Service Framework (NSF) for Older People.1 Increasingly, emphasis is placed on preventive health care, which ideally should be in place throughout life. Primary care organisations, reflecting on reconfiguration or development of new service delivery models for the often vulnerable elderly patient group, need to consider both chronic disease management2 and medication management.1 These services should be embedded within a robust infrastructure that supports collaborative and multidisciplinary working between health professionals.
In this article, a pharmacist-led osteoporosis medication management clinic service is described. A menopause clinic is also mentioned, as this was the forerunner of the osteoporosis clinic. By providing structured pharmaceutical care (Panel 1, p232),3 the pharmacist aims to ensure efficacious medication. It is accepted that the patient will be provided with components of health care from many health professionals, including those based in primary and secondary care sectors. Lifestyle intervention and falls prevention advice are an integral part of the medication review offered by the clinic, to help promote health and independence with ageing.1 Further discussion highlights how work in progress and development will facilitate enhanced delivery of patient care.
The evolving model incorporates improved liaison between the secondary and primary care health professional teams, with the pharmacist in post as a practitioner with a special interest2,4,5 and appropriately qualified to take on prescribing responsibility. Direct patient benefits include improved access and further choice for advice on medicines,6 and engaging in a concordance partnership1,7,8 to agree an individualised management plan. The strategic remit for the pharmacist practitioner5 encompasses use of mechanisms such as guideline development, a health professional telephone link-line to offer support, and multidisciplinary educational initiatives9–11 including formulary and audit work to standardise and underpin evidence-based provision of patient care across the local health economy.
Our work supports the concept of pharmacists undertaking medication review at level three12 (Figure 1, p234) and ongoing management within the hospital setting. Preliminary research before setting up the menopause and osteoporosis medication clinics included the investigation in-depth, using action research methodology (see Panel 2, p234),13,14 of the role of a specialist menopause pharmacist (1996–99).15 This role is accepted both by patients16 (Table 1, p235) and health professional colleagues.15,17,18 The remit for the specialist pharmacist practitioner has been defined as combining clinical practice (service delivery), a teaching and training commitment, and research studies with emphasis on strengthening liaison between the secondary and primary care sectors.15
Service and referral
The weekly specialist menopause clinic offers an outpatient service on Thursday mornings, while the bone metabolic unit, located within the arthritis centre offers its osteoporosis outpatient clinic on Tuesday afternoons. These clinics offer patient care from within a district general hospital setting, providing services to two main primary care organisations with a total catchment population of over half a million.
The medication management clinic operates on-site, in parallel to the consultant-led outpatient clinics.9 This infrastructure uses health professional skill mix and supports good collaborative, multidisciplinary team working. This was identified as important from the outset to achieve our vision of providing seamless care to the patient, to include clinical, health and medication management. The clinics have their own computerised patient lists, with referrals triaged by the consultant or senior registrar.
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Citation: Hospital Pharmacist URI: 10977331
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