Pharmaceutical Care Awards
Keeping patients safe when they transfer between care settings
Consultant pharmacist-led case management service focused on older people in intermediate care wins Pharmaceutical Care Award.
Source: Nadia Attura
Older people can benefit from specialist pharmacy input in an intermediate care setting, researchers in Northern Ireland have found. A team at Western Health and Social Care Trust designed a consultant pharmacist-led care pathway for older people discharged from an acute hospital into intermediate care. The team was judged the winner of the Pharmaceutical Care Awards 2014.
The consultant pharmacist assumed responsibility for all patients from admission until they were discharged back into the community, and additionally for a minimum of 30 days post-discharge.
Ruth Miller, lead pharmacist in research and clinical trials, described the rationale for the project in a Q&A session at the awards. “The idea goes back to 2010 when the chief pharmacist of NI was looking at the way forward for the pharmacy profession,” she said.
Miller explained that improving the care of the ageing population was high on the NI health agenda and, locally, the team had identified clear gaps in the provision of pharmacy services in intermediate care. “We also wanted to look at the role of the consultant pharmacist; this is the first consultant pharmacist in NI, therefore we wanted to get evidence for [introducing] that role,” she added.
Carmel Darcy, consultant pharmacist for older people, was the pharmacist responsible for providing the service. When questioned about what challenges the team faced when undertaking the project, Darcy explained that keeping focused on the vision for the project proved difficult when first engaging with stakeholders because other gaps in the service were identified along the way.
Each patient received a medication review by the pharmacist on admission and the appropriateness of each medicine was assessed using the Medication Appropriateness Index (MAI). Any necessary changes to medication regimens were made according to the patient’s pharmaceutical care plan. Adherence issues were addressed and appropriate interventions were made when needed.
Post-discharge, the consultant pharmacist continued to manage patients’ care through regular contact with GPs, community pharmacists or with the patients and carers themselves.
It was a top-heavy model. But we still got a very good return from the initial investment
According to project manager Miller, the generation of robust evidence to support pharmacy services was another key driver in the design of this project.
“The need for research was high and the project was initially designed to be a randomised controlled trial, which needed a very tight protocol,” she said. “However, it was later thought that ethically, although we were not taking anything away [from the control arm], we had in fact been funded to deliver the service to all patients. So, we had to redesign the methodology and evaluation of the project to be a service evaluation.”
The service was evaluated over 12 months and the following outcomes were measured:
- Number and impact of clinical interventions made by the consultant pharmacist
- Readmission rates within 30 and 90 days after discharge
- Net cost savings of stopping inappropriate medicines
Some 1,122 clinical interventions were made by the consultant pharmacist, 84% of which had significantly improved the standard of patient care, as determined by the team.
Readmission and inappropriate prescribing were also reported to have reduced as a result of the service. The team estimates the annual cost savings that can be generated by the service are in excess of £120,000.
“It was a top-heavy model,” remarked Darcy, defending the need for consultant pharmacist involvement. “But we still got a very good return from the initial investment.”
“[We needed] the key functions of a consultant pharmacist — providing specialist expertise, service development, research, leadership and education, and the interplay of all those functions — to deliver,” she added. ”Our vision was for this to be a leadership role and to create a model that can be rolled out by an advanced specialist pharmacist. We have been successful in that we have taken the evidence, shared it with commissioners and secured funding for a second respiratory pharmacist.”
Miller and Darcy were joined on the project team by Anne Friel, head of pharmacy and medicines management at the Western Health and Social Care Trust, and Mike Scott, head of pharmacy and medicines management at Northern Health and Social Care Trust.
The research is currently being prepared for submission to a peer-reviewed journal.
About the awards
The Pharmaceutical Care Awards 2014 were held on 19 June at the Royal Institution in London. The awards are run by The Pharmaceutical Journal and the Royal Pharmaceutical Society (RPS) and are supported by GlaxoSmithKline (GSK).
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20065865
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