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General Practice / Pharmacist Patient Centred Integrated Care

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    General Practice / Pharmacist Patient Centred Integrated Care General Practice / Pharmacist Patient Centred Integrated Care Presentation Transcript

    • Presenting Author: Dr Ian Williams Co-Authors: Mr Christopher Freeman Mrs Jan Chaffey General Practice / Pharmacist Patient Centred Integrated Care A model to consider
    • RACGP Clinical Guidelines
      • To manage chronic illness effectively requires
        • Well co-ordinated patient centred care that is:
          • continuous,
          • comprehensive,
          • and consistent
    • Have you ever considered having a Clinical Pharmacist work in your practice?
      • I hadn’t until I visited a rural practice that employed a clinical pharmacist performing Medication Reviews.
      • I wondered if this would be effective in our suburban practice?
    • Why leave pharmacists in the pharmacy?
      • In our practices we already work with other disciplines
        • Registered and enrolled nurses
        • Practice Management
        • Mental health nurses and Psychologists
        • Psychologists, Dieticians, Podiatrists, Occupational therapists & Social Workers
    • Guidelines for patients who may benefit from a Home Medication Review
      • Currently taking 5 or more medications
      • Taking more than 12 doses of medication a day
      • Significant medication changes in the last 3 months
      • Taking medications with a narrow therapeutic index
      • Experiencing symptoms suggestive of an adverse drug reaction
      • Experiencing sub-therapeutic response to treatment
      • Have suspected non compliance or inability to manage medication
      • Are attending a number of different doctors
    • Case study of 85 year old lady with intractable nausea and vertigo
      • 3 month history of intractable nausea
      • Complicated Medical History
      • Active problems included:
      • Controlled CCF
      • IHD
      • HTN
      • Ulcerative oesophagitis
      • Fatty liver
      • Chronic AF
      • Hypercholesterolemia
      • Hypothyroidism
      • Insomnia
      • Osteoarthritis
      • Diverticulosis
    • Medications at time of review
      • Akineton
      • Arthro aid
      • Avapro
      • Brufen
      • Marevan
      • Moduretic
      • Murelax
      • Oroxine
      • Panadeine forte
      • Pariet
      • Serc
      • Prn:
        • Dymadon
        • Elocon ointment
        • Mylanta
        • Periactin
        • Stemetil
        • Systane eye drops
    • Pharmacist Recommendations
      • Unknown to the General Practitioner Digoxin had been commenced two months earlier by the cardiologist
      • Postulated that Digoxin was the cause of nausea.
      • Digoxin ceased – symptoms resolved
    • Advantages of a Home Medication Review performed by a practice based pharmacist.
      • Timeliness
      • Patient centred
      • Access to full Clinical Record
      • Workforce
      • Safety and Quality use of medication
    • Possible future roles of a Practice Based Pharmacist
      • Home Medicines Review
      • Residential Medication Management Reviews
      • Medication Reconciliation
      • Medication use research
      • Chronic disease management
      • Compliance assessment and counselling
      • Patient education
      • Drug information service
      • Adverse drug reaction management
      • team member
    • Possible future roles of a Practice Based Pharmacist
      • Management of services / systems to ensure medication safety on a practice basis
        • Warfarin dosing
        • Leading the National Prescribing Service agenda in the practice.
      • Management of systems to enhance medication safety across related facilities.
    • The Business Case for a Pharmacist in the Practice
      • In Development
      • The Economic Value of Home Medicines Reviews ( VALMER) showed limited value, but improved targeting of patients may improve the cost effectiveness.
      • In the same way that practices need to do their own financial and business analyses when they employ a practice nurse, so to, must practices use these skills when considering a practice based pharmacist.
      • For me and my practice, we will continue to embrace our Practice Pharmacist.
    • Questions?