EVALUATION


challenges during the pilot.


‘Initially some of the pharmacists felt a little out of their depth because they had never done anything so clinically intensive before,’ she continued. ‘To counter this lack of confidence, we instigated the ‘buddy system’ whereby they worked with an existing PSP until they felt confident enough to work alone.


‘For some, this was the first time they had undertaken formal reviews in the care home and working within the GP setting, and they found this aspect enjoyable and rewarding.


‘Whilst working within the GP practice environment was enjoyable and allowed the pharmacist to develop relationships with the practice team, this was challenging for some participants if they were unknown to the practice. This had occurred for some due to an increase number of possible participants within one of the HSCPs and the individuals were asked to review care home patients in another area. Whilst this proved to be challenging, it did allow for another aspect of care to be tested where there had been no previous relationship or dialogue between the two respective parties.’


Nevertheless, despite these challenges, Elaine feels that the pharmacists – and the patients – benefitted from the pilot.


‘Despite an initial lack of confidence, there is no doubt that all of the pharmacists – particularly the non prescribers – benefited from this project. They all settled into a clinical mindset very quickly and there’s no doubting the success that came from the interventions that were made.


‘There was also an interesting sidepoint to the pilot that we hadn’t anticipated. When the pharmacists went back into their own pharmacies, they all adapted their practice to reflect these new ways of delivering pharmaceutical care.


CONCLUSION


‘Due to the increasing pressure within GP practice and the national strategic direction, there is a need to develop a model where all pharmacists provide pharmaceutical care for this vulnerable group. Local development of care home services could be extended to include a need for a formal medication review and the skills/


knowledge learned with this pilot was used for other vulnerable groups, including those patients receiving multi-compartmental aids (MCA).


‘Unfortunately, there was no information recorded that demonstrated if this model had any impact on reducing GP visits to the care homes. There has also not been any follow-up to assess if the work had any impact on reducing hospital admissions for this patient group.


‘In terms of cost savings, the cost to provide the service included the initial training session, plus a sessional payment for each four-hour block that was used to undertake the review..


‘The cost per patient reviewed was between £93.75-£107.50. However, payment for the IP would be more cost-effective as there was also less input from the PSP peer for an independent


prescriber, and they were also able to make any recommendations and changes directly, thereby reducing time to complete each review.


‘I think that, overall, and taking everything into consideration, the model fitted better with someone with an IP qualification. Unfortunately, it wouldn’t be possible to make contractual changes in this field at the moment as there simply aren’t enough IPs. I am aware that there are some qualified IPs wanting to get involved in medication reviews and, as the number of IPs grows, it may be possible to replicate this pilot across a broader area.


‘Certainly, I feel that, based on the local pilot work undertaken with regards to community pharmacy involvement in medication reviews for patients in care homes, there is evidence to support this approach.


‘However, consideration of the time to review each patient and the cost of providing the review per patient seen and the cost of the service needs to be considered against the potential savings which could be made. The model where reviews are undertaken using both GP and care home notes is more beneficial and provides better information in order to make recommendations to the prescriber. It also allowed the community pharmacist the opportunity to provide education to the care home staff if they were present in the home.


‘The outcomes would suggest that this approach is worth developing further but will need a more formal arrangement to ensure that the GP practices are aware of the service and seek their support for the community pharmacist to access clinical and care home notes.’ •


SCOTTISH PHARMACIST - 25


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