TELEHEALTH
Dispensing GP practices around WI were asked to submit notes of interest to the Steering Group and, as a result, two GP surgeries – Ben Becula Medical and North Uist – were initially selected. A third – North Harris – was approached at a later date as the pilot progressed.
Clinical pharmacists were then given remote access into the GP system (EMIS) and appointments were via videoconference (VC) (the patient had to attend the GP surgery for VC), or by telephone at the patient’s home.
‘GP practices then sent out invitation letters to a selected group of patients,’ Dawn continued, ‘and these included a leaflet explaining what this pilot was about. Initially this was done as an ‘opt-in’ system, whereby the patient had to make contact to make an appointment to speak to the pharmacist. However, we found very quickly that numbers were small and so a different ‘opt-out’ approach to taken with the pharmacists calling patients instead.
‘Interventions from medication reviews were quantified on a set template and questionnaires were sent out to patients post review. All interventions made including referral back to GP for review of certain issues were entered in EMIS remotely post consultation.
‘Patients selected were largely based on the number of medicines prescribed, as well as those on high-risk medicines, such as lithium, methotrexate, anticoagulants, insulin, hypnotics and long-term antibiotics).
‘A total of 179 patients were reviewed between February and September last year and the data was evaluated by Robert Gordon University in Aberdeen.
‘From all of our interventions recorded, 46 per cent were counselling and advice, while 54 per cent were pharmaceutical care issues requiring alterations to patients’ medications, such as stopping and starting medicines, increasing or decreasing doses, interactions etc. A high number of care issues (on average four care issues to one patient) were identified.
‘The overall consensus by GPs and patients from the beginning was that the medicines review with the pharmacists had enhanced care, particularly in terms of increasing the patients’ knowledge of their medicines. In fact, from the questionnaire feedback received from 62 patients, all said they were happy
with the advice given. There was a high appreciation of the service and everyone expressed a desire for the support to not only be continued, but to be expanded.
‘We definitely learnt very quickly on the job what worked and what didn’t. The majority of the patients (85 per cent), for example, received a telephone call rather than face-to-face consultation, and, while most of them expressed a preference for face to face, they were aware of the logistic issues being in a remote location with less reliable internet connection. Most of them were not willing to make a trip to the GP surgery for VC connection and took up the option of telephone conversation.
‘We also became quickly aware of the barriers pharmacists faced - especially with telephone consultations. They were, for example, unable to check issues like adherence or using medicines, such as inhaler technique, primarily because they couldn’t see non-verbal cues. They also found it difficult to persuade some patients to share information when doing a review over the phone, but, despite that, there were still care issues picked up via this consultation route. Also, there were some patients who were unsure of the role of pharmacists, with many asking what the pharmacist could offer that the GP wasn’t already doing, so we became aware that there was a need to increase awareness in remote locations. For that, we needed the support of the GPs to assure the public. Telephone consultations alone take time to build a relationship with a patient, and so there was a feeling that an initial face to face would boost the rapport.’
The pilot proved to be a major success, with patients not only referred to GPs but to other services, such as chronic pain, smoking cessation, dietitians, cardiac rehab and the diabetes team – services which patients may not previously have been aware of.
‘Initially there was increased workload for GPs and practice staff,’ said Dawn, ‘primarily because, with this new service, more referrals were made to GPs and so patient appointments had to be facilitated and organised. However, with the appointment of one primary care pharmacist - and a second soon – we envisage a reduction in the GP workload to allow GPs to have more time in other critical areas.’ •
‘WE ALSO BECAME QUICKLY AWARE OF THE BARRIERS PHARMACISTS FACED - ESPECIALLY WITH TELEPHONE CONSULTATIONS. THEY WERE, FOR EXAMPLE, UNABLE TO CHECK ISSUES LIKE ADHERENCE OR USING MEDICINES, SUCH AS INHALER TECHNIQUE, PRIMARILY BECAUSE THEY COULDN’T SEE NON- VERBAL CUES.’
DR KEITH BURNS, GP PRESCRIBING LEAD FOR NHS WESTERN ISLES, BELIEVES THAT THE APPOINTMENT OF PRIMARY CARE PHARMACISTS WILL BRING MAJOR BENEFITS TO BOTH GPS AND PATIENTS ALIKE.
‘Eight of the nine GP practices that are involved in the scheme are dispensing practices,’ Dr Burns told SP. ‘For that reason, many patients on the islands would never see a pharmacist unless they were admitted to hospital.
‘There’s no doubt that the patients have responded extremely well to this new service and are actively looking for pharmacy advice. The face-to-face approach is, I think, one of the main positives about the new service and patients are learning how to ask for advice on their medications.
‘Liam sets up his consultations – which usually last about fifteen minutes – although sometimes they can be longer if they’re more complex issues, such as polypharmacy or high-risk medicines. He’s also able to focus on different projects at different times and this is a major benefit to GPs. The fact that he spends set days in set surgeries means that the GPs know he will be there and can be prepared to discuss specific issues with him. In all, I think that the success of the pilot has been more than justified in the creation of these new posts. It’s a win-win for all concerned.’
SCOTTISH PHARMACIST - 37
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