This year's Pharmacy Team Member of the Year Award has transformed a gap in care into an opportunity. Traditionally, housebound patients had frequently missed annual chronic disease reviews and often had to be cared for reactively rather than preventatively. The work Louise does has changed that.
The clinical pharmacy technician leads the care at home pharmacotherapy service, serving highly deprived communities in Glasgow. Through structured home visits, she delivers holistic medication reviews, clinical observations, phlebotomy, frailty scoring and medicines optimisation in patients’ own homes.
Many of the patients she sees are elderly, with a median age of 81, have an average of seven comorbidities, are on complex regimens with an average of 14 medications and live in socioeconomic deprivation. Despite the fact these patients had a significant clinical need, they had previously been excluded from standard annual review pathways.
Louise recognised that medication safety, falls risk, cognitive decline and frailty could not be assessed remotely in an adequate way. So she has pioneered an innovative domiciliary model that includes visiting patients in their home to carry out:
• Structured medication literacy education and adherence assessment
• Clinical observations (including manual blood pressure, pulse rhythm assessment, oxygen saturation, respiratory rate)
• Diabetic foot assessment and peripheral oedema screening
• Blood and urine sampling within the home setting
• Frailty scoring, cognitive screening and quality of life assessment
Her findings are then discussed with the clinical pharmacist, allowing for shared decision making and medication optimisation. Her detailed home assessments allow the pharmacist to focus on complex prescribing decisions, supported by real time clinical data. Louise’s visits also consolidate tasks that would otherwise require multiple GP appointments, reducing pressure on practice teams.
During a three month service evaluation, 83 patient visits were completed. Early identification of heart failure led to timely referral for two patients. In total fifteen onward referrals were generated across cardiology, renal, endocrine, memory, mental health and social care pathways. There was also a reduction from eight falls to zero falls over the same period of time.
Medication optimisation during the pilot included 21 medicines being discontinued, 19 started, and 15 dose changes, reducing anticholinergic burden and inappropriate polypharmacy and resulting in projected savings of £125 per patient. The service has reduced unscheduled care appointments from an average of 56 to 21 over a three month period.
During one visit, Louise identified and managed a hypoglycaemic event in an insulin dependent patient who was home alone. She contacted the practice, liaised with the pharmacist and GP, provided immediate nutritional support, remained with the patient until safe and then escalated to the specialist diabetes nurses for insulin adjustment. Her actions that day prevented a potential hospital admission.
Louise’s work has demonstrated how a pharmacy technician can extend the boundaries of primary care, delivering structured, preventative, person centred medicine where it is most needed, in patients’ homes. It has ensured housebound patients receive the same quality of preventative in person care as those able to attend surgery appointments.
"Louise’s work has demonstrated how a pharmacy technician can extend the boundaries of primary care..."
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