Transcript Public Health Service

Overview of Pharmacy
Services
Gail Caldwell
Pharmacy Director
June 2012
Where are pharmacy services?
HOSPITAL
SPECIALIST SERVICE
E.G. SUBSTANCE MISUSE
COMMUNITY
PHARMACY
(CHEMIST
MEDICATION REVIEW
IN GP PRACTICES
What do community pharmacists do?
• Known as chemists, like GPs part of NHS
family
• 94% of the Scottish population visit a
community pharmacy at least once a year
• Situated in heart of communities, open
long hours therefore accessible health
care professionals
• Traditional role, dispensing prescriptions
written by doctors changing
Traditional Community Pharmacy
Modern Community Pharmacy
Community pharmacy contract
• Acute medication service (AMS), is the provision of
pharmaceutical care by community pharmacists for
acute episodes of care;
• Minor Ailment Service (MAS) allows patients exempt
from prescription charges to access a range of
medicines free of charge with supporting advice directly
from their community pharmacy;
• Public Health Service (PHS) where pharmacists will
provide information on public health issues, create public
health window displays and participate in national and
local public health campaigns and
• Chronic Medication Service (CMS) formalises the role
of community pharmacist’s in the management of
individual patients with Long Term Conditions in order to
assist in improving patient’s understanding of their
medicines & optimising the clinical benefits from their
therapy.
• Locally negotiated services
The Brown Family
The Brown Family
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Grandfather (68 years old)
Grandmother (66 years old)
Father (42 years old)
Mother (38 years old)
Daughter (18 years old)
Daughter (10 years old)
Mrs Brown Junior (aged 38) –
Acute Medication Service (AMS)
• Regular medication of Lamictal
• AMS prescription for
ciprofloxacin (antibiotic) to treat
urinary tract infection
• Potential drug interaction – can
lower seizure threshold
• Pharmacist contacts
GP/discusses with patient,
Lamictal for trigeminal neuralgia
• OK to dispense ciprofloxacin
Caroline Brown (aged 10) –
Minor Ailment Service (MAS)
• Suffering from Head Lice
• Pharmacist consultation
• Recommends checking the
rest of the family
• Pharmacist prescribes
Hedrin Solution & Head Lice
Comb
• Advice – no swimming, use
solution as directed, comb
hair daily
Samantha Brown (aged 18) –
Public Health Service (PHS)
• Enquires about ‘morning after pill’ or
emergency hormonal contraception
(EHC)
• Consultation with pharmacist in private
consultation room to assess suitability
for EHC
• EHC prescribed
• Advice and information re Sexually
Transmitted Infections-offered
Chlamydia postal testing kits
• Signposting to other health care
professionals for ongoing contraception
• Patient confidentiality
Mr Brown Junior (aged 42) –
Public Health Service (PHS)
• Smoked since teenager – motivated
to quit
• Pharmacy Smoking Cessation
Service (part of Public Health
Service)
• Pharmacist consultation – provides
information, advice, monitoring,
prescribes Nicotine Replacement
Therapy (NRT) patches for 1 week
• Pharmacy team offer ongoing
support and further supply of NRT
Mr Brown Senior (aged 68) –
Chronic Medication Service (CMS) & Overthe-Counter (OTC)
• History of peptic ulcer
• Receives regular prescription
for omeprazole 20mg daily
• Asks to buy ibuprofen 400mg
for sore knee
• Pharmacist intervenes –
recommends paracetamol
instead
• Suitable for CMS registration
Where are pharmacy services?
HOSPITAL
SPECIALIST SERVICE
E.G. SUBSTANCE MISUSE
COMMUNITY
PHARMACY
(CHEMIST
MEDICATION REVIEW
IN GP PRACTICES
Mrs Brown Senior (aged 66) –
Medication Review Clinic
• Attends the over 65 pharmacist
medication review clinic
• Current repeat prescription:
– Bendroflumethiazide 2.5mg one tablet
in the morning
– Fosamax 70mg one tablet each week
on a Wednesday
– Calcichew D3 one tablet twice a day
– Co-codamol 30/500mg effervescent
tablets – two tablets up to four times a
day when needed for pain
Mrs Brown Senior (aged 66) –
Medication Review Clinic
• Orders all her medicines regularly –
remembers to take them as prescribed
• History of high blood pressure,
osteoporosis in her spine (painful) and
fell and broke her arm last year
• Concerned about her poorly controlled
blood pressure
• Would prefer not to take any more
medicines
Mrs Brown Senior (aged 66) –
Medication Review Clinic
• Pharmacist discusses her
individual medicines
– Salt content of effervescent cocodamol tablets – recommends
changing to non soluble preparation
– Advice on correct administration of
Fosamax – recommends changing
to generic product
– Recommends changing her calcium
& vitamin D preparation to Adcal D3
which contains the recommended
amount of vitamin D
Where are pharmacy services?
HOSPITAL
SPECIALIST SERVICE
E.G. SUBSTANCE MISUSE
COMMUNITY
PHARMACY
(CHEMIST
MEDICATION REVIEW
IN GP PRACTICES
Mr Brown Senior-admitted to
hospital with chest pain
• Accurate medication history
obtained by pharmacy team
before seen by Consultant in
admissions unit
• Regular medications prescribed
• Patient - using wife's co-codamol
as paracetamol alone not effective
- pharmacist advised medical staff
to prescribe co-codamol instead of
paracetamol
• Diagnosed with suspected heart
attack
Mr Brown Senior-admitted to
hospital with chest pain
• Patient commenced on
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Blood thinning drug - clopidogrel
Cholesterol lowering agent - statin
ACE - Inhibitor
Beta blocker
GTN spray
• Clinical pharmacist advised of
interaction between omeprazole
and clopidogrel - potential to
reduce effect of clopidogrel lansoprazole given instead
Mr Brown Senior-admitted to
hospital with chest pain
• Patient advised on changes to medication by
pharmacist before discharge
• Counselled on use of GTN spray
• Advised that regular co-codamol could lead to
constipation - prophylactic laxative prescribed
• Discharge prescription generated by
pharmacist and sent electronically to
pharmacy for dispensing by robot
• Discharge letter sent electronically to GP after
6 hours
• Pharmacy Care Plan report shared with
community pharmacist on discharge to advise
of changes to medications and outstanding
issues
Where are pharmacy services?
HOSPITAL
SPECIALIST SERVICE
E.G. SUBSTANCE MISUSE
COMMUNITY
PHARMACY
(CHEMIST
MEDICATION REVIEW
IN GP PRACTICES
Samantha Brown’s boyfriend,
Jimmy 22 yrs: substance misuse
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History of short opiate career, lost job and
started injecting 6 months ago.
Previously attended pharmacy for clean
injecting equipment
Pharmacist registered patient & provides
advice on hygiene, safe injecting, safe sex,
risks of Blood Borne Viruses (BBV) and
disposal of equipment
Pharmacist signposted to hepatology
service for hep B vaccination and hep C
testing
Pharmacist referred to Signpost Recovery
for overdose training and supplied naloxone
Pharmacy team provide information on
treatment services
Samantha Brown’s Boyfriend,
Jimmy 22yrs:substance misuse
• New relationship and motivated
to change injecting behaviour
• Recently engaged in treatment
and prescribed methadone
• Pharmacist works in partnership
with Addiction Recovery Service:
discuss treatment agreement
• Daily supervision of methadone
• Offers advice and health pack as
part of NHS Forth Valley oral
hygiene initiative
• Pharmacist provides support
during opiate substitution therapy
Conclusion
• Medicines can lead to significant health
improvements but they need to be managed well
so that patients get most benefit
• Pharmacy services key role
• Transformation from “product focused service” to
clinical profession, caring for patients and the
public
Medicines waste: NHS Forth Valley
Estimate £2.2 million
Repeat prescriptions
• Only order the items you need
• Are there any items you no longer require?
Speak to your GP or pharmacist
• Please don’t
– order “just in case”
– hoard
– Ask for a new prescription until you have
collected the full quantity from the pharmacy