PRACTICE-BASED PHARMACISTS


aS thE fIRSt tRaNchE Of PRactIcE-BaSEd PhaRmacIStS takE UP thEIR POStS, PIf SPEakS tO ONE NORthERN IRElaNd (NI) PhaRmacISt whO IS lEadINg thE way IN clINIcal PhaRmacy IN ONE Of thE mOSt REmOtE aREaS Of thE Uk.


tElEhEalth: thE way fORwaRd?


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ith practice-based pharmacists (PBPs) now in place as part of gP


federations, the connection between gP-based pharmacists and community pharmacists will, no doubt, become more important. But, while there's no doubt that PBPs will provide a welcome 'add-on' service to pharmacy in the community, there's still a way to go...


telehealth has proven to be very successful across a wide range of care situations in NI. Video conferencing (Vc), in particular, has been shown to help improve communication channels between healthcare professionals and patients. Over the last 18 months, for example, English company, Inhealthcare, has been working with the Southern health and Social care trust to pilot and evaluate a telehealth undernutrition service in care homes.


last year, the telehealth undernutrition service pilot and evaluation ran in fourteen care homes in NI: eleven in Newry and mourne, and three in armagh and dungannon. Residents at risk of undernutrition were closely monitored every one to two weeks by care home staff, who were able to input the patient’s weight, appetite, and compliance to oral nutritional supplements (ONS) into the web- based portal as part of their morning routine. If any of the patients' data fell outside of their pre-set clinical parameters, a member of the dietetic team was alerted to make


10 - PhaRmacy IN fOcUS


appropriate contact with the care home to provide dietary advice.


the telehealth undernutrition service not only enabled dietitians to save over two hours per patient enrolled onto the service – time, which could then be spent with more complex patients requiring their care – but care home staff were also able to feel empowered to take responsibility of the less vulnerable patients, where, previously, a dietitian visited every patient every six weeks.


telehealth has already been introduced in pharmacy and has been shown to benefit the care of remote and rural patients. Pif spoke to one NI pharmacist, who is now working for NhS highland in Scotland, and who told us how the role of the PBP could easily be extended to provide an expanded service.


In april 2015, NhS highland – which has an increasing elderly population, geography and sparse population density - set up a remote, clinical pharmacy service to five gP practices in lochaber.


'lochaber was chosen as previous work carried out by Scottish centre for telehealth and telecare and the NhS highland dementia team, who had set up a remote dementia clinic for care home residents, meant that facilities were already in place,' says Patricia hannam, telehealth lead pharmacist for NhS highland. 'and, with a lack of recruitment of a primary care pharmacist locally, it was


the ideal place to test if a remote, primary care, clinical pharmacy service could be provided with a pharmacist recruited centrally.


‘my work is to perform medication reviews and provide prescribing support to five gP practices and their four care homes. this is done from my office base, larachan house, dingwall, 100km away from these gP practices.'


Patricia's first task was to create remote access with the gP computer systems. with the help of the NhS highland ehealth team and the support from the Scottish government, direct remote access was set up to three practices and shared desktop access to two practices. Ongoing work is looking at how to link with other gP practices remotely as the service develops.


'the first stage of the work is to perform medication reviews of care home patients,' Patricia continues. 'future stages are to review care at home patients and other gP practice patients who would benefit from a pharmaceutical review, eg, the frail and elderly, patients on multiple medications and, those at risk of falls. this supports the aims of promoting self care and helping patients to stay healthy and in their own homes for longer.


'to perform medication reviews, I access the patients’ records on the gP system to check their current medication, allergies and conditions,


Patricia Hannam


I check their blood and test results and review that each medication has a current and valid indication for each patient. having access to the full patient record means that I am able to check their history to answer any queries which their treatment brings up.


'I then arrange a pharmacy medication review clinic via video- conference with the patients. at the clinic I am able to assess the patients’ understanding of their medications, ask if they have any problems or questions and check for adverse drug reactions. we then discuss a plan for their medication and, if there are any changes agreed, this is then fed back to the gP in the form of a pharmaceutical care plan for the gP to agree and action.


‘So far, the service has been well received by patients and staff and I find that telehealth is an enabler to collaborative working; clinicians can meet together virtually in a way that wouldn’t be possible physically. I regularly join multidisciplinary clinics and team meetings via video conferencing, for example, from dingwall I regularly join clinics run by the highland hospice in Invergordon or New craigs in Inverness to care homes in lochaber.


‘Putting the patient at the heart of the medication review and decision making follows the principles of patient-centred care.' •


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