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Case Study Four

 
CLINICAL MEDICATION REVIEW
Level 3 by practice support pharmacists in Channel locality of East Kent Coastal PCT

Background
During 1999/2000, discussions with healthcare and social service professionals working in Channel PCG highlighted a number of problems with medicines management in the community. In April 2000, the PCG board agreed to the development of a medicines management support service.
 
Objectives
The aim of the service is to provide patients with appropriate support to enable them to take their medicines effectively. Specific objectives included supporting a range of patient groups with their medicine taking including the elderly, people with epilepsy and people with mental health problems by:
  • Reducing problems associated with administering medicines
  • Reducing problems with medicines on discharge from hospital
  • Improving use of monitored dosage systems (MDSs).
 
Approach
Details of the service were provided to primary and secondary care health professionals, and to social services care managers. Referrals are made to the PCT prescribing team and patients assessed at home by one of the team. Clinical review is undertaken by the prescribing adviser and documented in a standard format. This action plan is communicated to relevant professionals involved with the patient's care. If a MDS is required, a community pharmacist is identified to provide this service.
 
Results
Between 1 April 2000 and 1 April 2002, 164 patients were referred under this scheme. The frequency of referrals has increased with time and is currently running at approximately 5 per week. On average each referral requires 2 hours of input from the team. The majority of referrals have come from social services care managers. This reflects the need within social services for more support to help patients manage their medication. Staff costs for the service were not separately funded but 8000 was committed recurrently, to fund the provision and monitoring of MDSs by community pharmacists. 29 patients were classified as being "at risk" from their medication. Drugs for which this was a significant problem included; analgesics, tricyclic anti-depressants, diabetic medication, antihypertensives, warfarin and digoxin.
  • For 17 of the referrals, admission to a care home was a real possibility if support was not provided with medicines. For all 17 patients a MDS was provided to enable carers to manage the medication. So far this has saved 228 months of residential home care, which equates to a saving of 263,000
  • 123 of the 136 patients who received interventions were successfully supported to take their medicines correctly and maintained their independence
  • The remaining 13 patients were not successfully supported to manage their medicines at home. This was usually because the patients were too ill or needed support from alternative services.
A patient and referrer satisfaction survey is currently being undertaken. 90% of patients receiving an intervention have been enabled to take their medicines correctly. This existence of the service means that these problems are no longer ignored or handled inappropriately, and patients are provided with individualised support not just offered a MDS device as an answer to every problem.
 
Comment
This example demonstrates the value of medication review within the bigger picture of health, independence and well being, when it is based on listening to patients and finding ways to meet their individual needs. It also shows that medication review can be highly cost effective, and that potential savings extend far beyond simply reducing the cost of the medicines themselves. One of the most positive aspects of the service has been the partnership that has developed between social services, GPs, district nurses and community pharmacists, to help solve patients' medicines problems.
 
Contact
Heather Lucas, Pharmaceutical Adviser at Channel locality of East Kent
Coastal PCT

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