AWARD WINNERS
EHEALTH AND INNOVATION IN PHARMACY PRACTICE
PATRICIA HANNAM, NORTH AND WEST OPERATIONAL UNIT, NHS HIGHLAND
PATRICIA HANNAM WAS INSTRUMENTAL IN THE ESTABLISHMENT OF A REMOTE, PRIMARY CARE, CLINICAL PHARMACY SERVICE IN NHS HIGHLAND, WHICH WAS DESIGNED TO OVERCOME THE INEQUITY OF ACCESS TO PHARMACEUTICAL CARE IN REMOTE AND RURAL AREAS.
The Scottish Government requires that care home residents receive six-monthly medication reviews by a pharmacist, and it is NHS Highland policy that Care at Home users who are receiving managed support, have a medication review by a primary care pharmacist.
In remote and rural areas of NHS Highland, as in other similar regions, however, there is inequitable access to pharmaceutical services. For healthcare professionals, in particular, it can be difficult to gain access to both patients andand to fellow professionals.
Attendance at case conferences and multidisciplinary team meetings from differing locations, for example, can be difficult, if not, on occasion, impossible. (In NHS Highland, travelling distances can be over 100km each way!)
Nonetheless, it is vital that patients in these areas are provided with a pharmacy service, particularly when it comes to issues such as medication reviews.
One solution to these difficulties was remote working, which would ensure that a community pharmacist and a primary care pharmacist could not only (remotely) attend monthly GP multidisciplinary team meetings, but could gain greater access to patients – including those in care homes - something which, prior to
40 - SCOTTISH PHARMACIST
this initiative carried out by Patricia and her team, had been simply unachievable across NHS Highland’s rural areas.
In order to set up a remote clinical pharmacy service for care home residents, NHS Highland eHealth, with Scottish Government backing, set up remote access between the pharmacist desktop and five GP practices in Lochaber: three with direct remote access and two via WebEx.
The initiative involved the establishment of a remote connection to the GP prescribing systems, both in principle and in practice. Since this has been achieved, patient consultations and meetings have been conducted remotely using telehealth technologies. Primarily aimed at care home residents, the service has been shown to be feasible and beneficial to patients.
Regular videoconference or telephone clinics are now performed with care home residents using the NHS Scotland videoconferencing network. These are aimed at having a patient and/or representative present, as well as a support worker to increase patient engagement, and adhere to patient-focused care. The outcomes of reviews are passed to the patient, GP, community pharmacist and relevant health care professionals, enabling joined-up working.
Arnd Mommers, Willach UK, Patricia Hannam North and West Operational Unit, NHS Highland, Dingwall and Charlie Denwood, Positive Solutions
The benefits of this project have already been recognised.
For a start, the initiative has improved the pharmaceutical care of remote and rural GP practice patients by not only improving patient engagement and satisfaction with their pharmaceutical care, but also by increasing patient understanding and concordance with their pharmaceutical care. As a result, there has been a marked improvement in patient healthcare outcomes as related to adherence to national targets.
The project has also increased collaborative working between pharmacy, the GP practices and the wider healthcare team, and has reinforced integrated care between pharmacy and health and social care.
The project is already well underway and data will now be collected over a two-year period, 2017-19. Following collation of the data, an evaluation will be carried out. The data currently being collected includes:
• Service user evaluation (patients, GP practice staff, and pharmacists)
• Types and numbers of pharmaceutical interventions made
• Clinic details • Health outcomes
• Types of patients that can be targeted
• Effectiveness of the different methods of remote consultation
The next stage of the initiative is to provide the service to Care at Home users, and then to other vulnerable patients as identified by the GP practice, such as patients who are frail, elderly, or have multi-morbidities. Once an effective model has been set up and evaluated, the aim will be to spread the model throughout NHS Highland.
Potential developments of the service would include the provision of peer support for health and social care staff, including community pharmacists, through a programme of virtual education and networking sessions.
Whilst this service has been set up to tackle the issues of access to services for remote and rural patients, aspects of the model could be transferred to aid collaborative working and as a tool to target difficult-to-reach patients in more urban settings. Elements of the model will be applicable for community pharmacy services in reaching their remote and rural, and difficult-to-reach populations.
In order to set up a model for spread, it will be necessary for multidisciplinary teams to identify similar settings and introduce the model to the new setting using normalisation process theory, thereby allowing for localised adaptations to the proposed service.
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