PLANNING
particular interest to me not only as a councillor but, again, as a member of a community pharmacy team. I was very aware of the vital role that the community pharmacist could play in preventing readmissions and, indeed, my views were backed up by two very important pieces of work which were carried out in the Northern Trust by Professor Mike Scott.
In one study, Professor Scott and his team investigated the benefi ts of a community services liaison pharmacist in addressing medication misuse in elderly patients, which occurs on both admission and discharge.
could really try to make a difference, we had to ask ourselves which specifi c areas needed to be looked at as priorities.
• When it came to the elderly, for example, we focused on asking important questions, such as:
• Why are so many elderly people being readmitted to hospital?
• How can we improve domiciliary care?
• How do we prevent accidents occurring in the elderly population?
• How do we ensure medicines safety, compliance and adherence?
In short, we had to ask ourselves how, as a council, we could prevent people from going back into hospital and, ultimately, from getting sick in the fi rst place through improved education in health and wellbeing.
PROOF OF VALUE OF COMMUNITY PHARMACY Naturally, this was an area that was of
In the study, Professor Scott worked with a number of patients, who had been released from hospital. There was one target group and one managed group, who were contacted on discharge by community pharmacy after two days, two weeks, two months and six months. Of the target group, 87 per cent were readmitted, while only 20 per cent of the group looked after by the community pharmacist were readmitted. Statistics such as these clearly highlight that, with community pharmacy playing a role in medicines management post hospital discharge for the elderly, there would not only be massive savings for the NHS in terms of no hospital readmission, but the benefi ts in terms of effi cacy and safety for the patient were invaluable.
In another study, Professor Scott produced a piece of work, which featured completion of a medication history for each patient on admission by the community liaison pharmacist. On discharge, updated medication record sheets were then faxed to the patient’s GP and community pharmacy. A survey of GPs’ and community pharmacists’ opinions who were involved in the study was then carried out.
In the study, one hundred and nine patients over the age of 60 on four or more medications were admitted by the medical admissions unit of Antrim Area Hospital. Of the 109 patients:
• 61 per cent had an incomplete medication history on admission
• 21 per cent who brought their own drugs were not dealt with appropriately in hospital
• 33 per cent of discharged patients had medication-related problems.
The creation of this service was felt
to be very useful by GPs (80 per cent) and community pharmacists (100 per cent), and a reduction in readmission rate of 2.4 per cent was seen in these patients compared to the average for this age group.
Both studies show that the intervention of the community pharmacist in relation to hospital admissions and readmissions is worth its weight in gold – literally!
HOW TO DELIVER THE SOLUTIONS
Once we had ascertained the questions we needed to ask, we had to ask ourselves: ‘How do we, as a council, deliver the solutions?’
As a fi rst stage, we decided that there was no need to reinvent the wheel, and so we went to North Ayrshire in Scotland – which is probably about seven years ahead of us in such initiatives – and looked at what various community groups and partnerships were doing in terms of integrated services and community education. This helped us to see – and to learn from others’ experiences – about the right and wrong things to do to make the process work.
As a member of a community pharmacy team in Northern Ireland, of course, I’m already very aware of the value of community-based work.
For a start, I know that community pharmacy is very well placed to deliver education in the community setting. We’re all aware of the great work done by Building the Community Pharmacy Partnership, but there are also many pharmacies such as our own, which organise and deliver health talks to smaller community groups. We recently delivered a six-week course on a variety of subjects, such as diet, asthma and COPD, diabetes, depression and blood pressure. Through these courses, we could see how little information people actually knew about these very crucial subjects.
With my council ‘hat’ on, I know it’s vitally important that we draw together all of these strands, such as education, awareness, accessibility to the right information in order to be able to deliver integrated care throughout our communities.
The success of that delivery will depend on the level of integration so, with that in mind, the next stage in our process was the establishment of
the Task and Finish Working Groups, which bring together those who have an interest in various aspects of the subject and who wish to contribute to the discussion.
INTEGRATION AND COLLABORATION Once these groups were being planned, it immediately became clear that these groups would tie in beautifully with the Integrated Care Partnerships (ICPs), which are all up and running now and already involved in some tremendous work. Collaboration, we knew, would help us all with our goals.
To engender this collaboration, Dr Brian Patterson, the ICP Clinical lead, came and presented to the council on the work of ICPs and how it could be integrated with our work to deliver.
This new-found spirit of collaboration and integration will be the key to the success of this model. As I said earlier, where previously the government bodies would speak with you, it wasn’t as a ‘partner’. We’re still in the early days and there’s no doubt that some mindsets will need to change a little. I get the impression from some of our larger partners that they see council as a partner who is there to fi t in behind what they have already decided and to endorse those decisions. I truly hope that that initial perception is incorrect, and that as we work together, it will become a true and equal partnership of cooperation and collaboration. That relationship is the only way to deliver for the patient at the heart of our constituencies. It will take time and a lot of patience and understanding, but we’re partnering with people who have never had to partner meaningfully with us before in order to deliver targeted services in a much more effi cient manner. There are bound to be some teething problems.
I’ve said since I came to work in the fi eld of pharmacy some ten years ago, that community pharmacy is a massively underutilised resource for health issues. There are over 500 community pharmacies, many placed at the heart of their local communities and all with a very trusted professional relationship with those who need the most help. Do I believe that community pharmacy can deliver for community planning? Absolutely. It is a drum I will beat and continue to beat at all levels of government. •
PHARMACY IN FOCUS - 59
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