In March 2018, the National Institute for Health and Care Excellence (NICE) published its guideline NG94: ‘Emergency and acute medical care in over 16s: service delivery and organisation’. In this guideline, two chapters focused on pharmacy’s contribution to the delivery of emergency and acute care in the NHS. I was fortunate enough to have been part of the technical team who developed this guideline, as a senior health economist. My role was focused on systematically reviewing the published economic evidence for topics considered in this guideline, including the two pharmacy-related ones, to which I would like to draw your attention.
The first review assessed the effectiveness and cost-effectiveness of enhanced roles provided by pharmacists in the community setting, and the second assessed the outcomes of having a ward-based pharmacist for either seven days or less than seven days a week. The results of these two reviews confirmed the cost-effectiveness of enhanced roles provided by pharmacists at community pharmacies and general practice settings, but not at people’s homes. They also supported the cost-effectiveness of regular ward-based pharmacist input. These findings, alongside the effectiveness evidence from randomised controlled trials, were considered by the guideline committee in its discussions and ended up informing the following guideline recommendations.
1.1.3 For people who are at increased risk of developing a medical emergency:
- Provide advanced community pharmacy-based services;
- Consider providing advanced pharmacist services in general practices.
1.1.4 For people at risk of an acute medical emergency, do not commission pharmacists to conduct medication reviews in the home unless needed for logistical or clinical reasons.
1.2.7 Include ward-based pharmacists in the multidisciplinary care of people admitted to hospital with a medical emergency*.
*NICE’s guideline on medicines optimisation includes recommendations on medicines-related communication systems when patients move from one care setting to another, medicines reconciliation, clinical decision support, and medicines-related models of organisational and cross-sector working.
These recommendations should support the case for funding enhanced services provided by pharmacists at community pharmacies, as the evidence shows their cost-effectiveness.
It is surprising that there is little awareness of the existence of these NICE recommendations in the UK. It is important that commissioners take note of these recommendations and implement them to maximise the benefit that could be gained from pharmacists’ contribution to the emergency and acute care service provision in the NHS.
I believe that March 2018, the date of publication of the NG94 guideline, should be added as one of the NHS70: major moments in pharmacy, outlined in The Pharmaceutical Journal’s infographic!
Dalia M Dawoud, lecturer, Department of Pharmacy, University of Hertfordshire
You may also be interested in
The importance of diverse clinical imagery within health education
Government should consider ways to prevent ‘inappropriate overseas prescribing’ of hormone drugs, review recommends
