Pharmaceutical Care Awards
Pharmacists take a lead in community falls prevention
Launching a community falls prevention service has identified at-risk patients and strengthened ties with secondary care teams.
Source: Nadia Attura
A week before Christmas 2013, Doncaster Local Pharmaceutical Committee (LPC) was approached by the local Clinical Commissioning Group (CCG). It wanted pharmacists to deliver a falls service as part of its winter pressures programme — and it wanted this to happen immediately. Despite the limited time and the heavy seasonal workload, the team put together a service that became a finalist at the Pharmaceutical Care Awards 2014.
The CCG’s approach followed an earlier pilot the LPC had put together, Doncaster community pharmacist Claire Thomas told the audience in the awards Q&A. “Back in 2010–2011 we’d started to talk with GPs about a falls service as part of an extension of Medicine Use Reviews (MURs),” she said. “Patients were targeted opportunistically to have a consultation with the pharmacist, which involved identifying high-risk medicines and potentially fall-inducing side effects. The pharmacist assessed gait and balance, and enquired about urinary incontinence and vision problems, which are risk factors for falls.”
The service was designed to address a local need. Doncaster does not have a multidisciplinary falls prevention service and there are no clear referral pathways. The only falls prevention service in the area requires a patient to have fallen in the past 12 months, meaning that it cannot focus on primary prevention. This is despite a pressing need: between April 2013 and February 2014 there were 2,409 emergency admissions to Doncaster Royal Infirmary caused by falls, at a cost of more than £6.4m.
“We knew falls were an issue in Doncaster,” Doncaster LPC chairman Richard Wells said. “When you talk about falls, GPs focus on aftercare. We kept trying to focus the debate on prevention because we could clearly see that that’s where pharmacists have a role to play.”
The falls service launched across 23 pharmacies in January 2014, with pharmacies paid £10 per consultation. Patients recruited to the scheme either volunteered for the advertised service after a fall or were identified by dispensary staff as potentially benefitting from it.
We kept trying to focus the debate on prevention because we could clearly see that’s where pharmacists have a role to play
Pharmacists conducted more than 400 consultations in the first three months and found that 95% of patients assessed were on one or more high-risk falls medicines, 32% were experiencing falls-inducing side effects and 23% had gait or balance problems. Most of the interventions were carried out by the pharmacist, with 10% of patients referred to the specialist falls service for having a fall in the previous year.
“We have built a good relationship with the secondary care falls service in Doncaster,” Thomas said. “We thought [our service] was going to be a primary prevention service but we have also identified a group of patients who had a fall but hadn’t told anyone. This is a group of patients who, if the service wasn’t running, wouldn’t have had access to specialist services.”
Duplication and replication
Despite this success, the service has faced problems, largely because of its rapid implementation. “There was too much paperwork,” Thomas told the audience. “We didn’t have the chance to pilot the resources. We also realised we needed a certain amount of data to evaluate the service but the CCG wanted more information with the claim forms. We didn’t know that at the time, so there was a duplication of information.”
Another key issue was encouraging already-busy pharmacists to get behind the service. “It would be great to say every pharmacist in Doncaster took part,” Wells said. ”Clearly that wasn’t the case. We got pharmacists to come to training sessions. We have one contractor with a large number of contracts in the area and pushing through that network helps. But we had less engagement from [large multiple] colleagues and independents.”
These issues are hoped to be ironed out in the future. The service is currently being evaluated by the CCG, with the LPC considering possible expansions to screen patients for osteoporosis.
For pharmacists looking to replicate Doncaster LPC’s success, Thomas recommends getting in touch with local services as a first step. “Try and find out what services are out there already; do you have anyone doing primary falls prevention work that community pharmacists could complement? Or do they have a specialist falls service or multifactoral assessments? They can identify key members of the team and implement some kind of referral.
“If we hadn’t built up this close relationship with the falls service and just referred patients to the GP practice, it would have had an impact on GP workload, affecting engagement with the service. If anyone is thinking of replicating this service, try and have those conversations and get those relationships established.”
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.2014.20065883
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