Transcript Pharmacy Practice in Scotland

The Pharmaceutical Care of
Patients with Long Term
Conditions
Deirdre Watt
Team Leader, Community Pharmacy
Scottish Government
Objectives
• Set out community pharmacy role
• Define concept of pharmaceutical care
• Describe the Chronic Medication
Service
• Consider clinical benefits
• Outline timetable for delivery
Community Pharmacy Role
• Developing the role of the pharmacist
Address health inequalities
Make better use of the workforce
Maximise clinical outcomes
• Public Health Service
Services and information
Smoking cessation clinics, sexual health advice
• Minor Ailment Service
Free for those who do not pay for prescriptions
Over 600,000 registered – treat or refer
The Patient Journey
• Patient has GP appointment
• Prescription taken to pharmacy
At least 5.2% of items not dispensed
• Patient takes medication
30-50% non-adherence
2.7% - 6.5% hospital admission due to Adverse
Drug Reaction (ADR)
• Outpatients
5% of medicines not added to the GP record
Minor Ailment Service
• Over 600,000
patients registered
• 90,000
consultations per
month
• Extremely positive
patient feedback
MAS Trends
• Registration
Over 60 - 40%
Under 16 - 33%
Income related - 19%
Maternity / HBE - 7%
16-18 (education) - 1%
• Prescribing
Paracetamol (18%)
Ibuprofen (7%)
Chloramphenicol (5%)
Malathion (4%)
Clotrimazole (4%)
Unscheduled Care PGD
• Provision of medicines under a national Patient
Group Direction (PGD) when a GP is
unavailable
• Pharmacist can give up to one prescribing cycle
of a patient’s medicines
• PGD covers all medicines in the British National
Formulary (BNF) – with exceptions detailed (e.g.
controlled drug, hospital only treatments)
Unscheduled Care PGD usage
Chronic Medication Service
(CMS)
Description
• Personalised pharmaceutical care for patients with
long term medical conditions.
Purpose
• Maximise clinical outcomes for patients
• Minimise predictable undesirable effects
• Increase patient understanding of their medicine –
increase compliance, reduce waste
Three Stages
3. Shared
care
1. Patient
registration
2. Pharmaceutical
care planning
CMS Outline
• Stage 1
Patient registers with a community pharmacy of their choice
Voluntary – register with one pharmacy only
Underpinned by patient consent
• Stage 2
Pharmacist assesses patient
Pharmacist develops a pharmaceutical care plan
• Stage 3
GP issues a serial prescription: 24 or 48 weeks
Pharmacist dispenses prescription at agreed intervals
Feedback to GP practice – end of care treatment summary
Review or repeat
Improved Concordance
Stage 2: Pharmaceutical care planning
• Patient and pharmacist
Discuss and assess the patient’s condition/s, medicine/s
and general health
Identify any issues / problems
Establish desired outcomes
Agree any actions to address them
• Pharmacist
Documents the issues, desired outcomes and actions in
a pharmaceutical care plan
Monitors and reviews the care plan
Timetable to CMS
• Early adopter testing in Fife
Develop toolkit for implementation
8 week consolidated end to end testing
• Registration
• Serial prescription
• End of care treatment summary
• Roll out from October
• Full CMS for patients with exemptions
• Complete roll out to all – April 2011
Summary – CMS Benefits
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Improved clinical outcomes
Improved concordance
Reduced wastage
Easier patient journey
Promotion of self care
Better utilisation of the workforce
Encourage team working
New Community Pharmacy
Contract Benefits
• Improved access
Medicines
Pharmaceutical advice
• Managing demand
GP practice
NHS 24
A&E
• Addressing health inequalities
• Shifting the balance of care