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Adding Additional Pieces to the Puzzle
 

Adding Additional Pieces to the Puzzle

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Presented at the Optimizing Medications Workshop in Vancouver by Mary Lou Lester

Presented at the Optimizing Medications Workshop in Vancouver by Mary Lou Lester

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    Adding Additional Pieces to the Puzzle Adding Additional Pieces to the Puzzle Presentation Transcript

    • Community Pharmacist Integration into the PIHC Renal CKD Patient Clinic • In 2011, Greg Wheeler, from Skaha Pharmacy (the British Columbia Provincial Renal Agency contract pharmacy in Penticton), proposed enhancing services to patients of the Penticton Integrated Health Centre (PIHC) chronic kidney disease (CKD) clinic, by performing medication reviews at the clinic.
    • Payment Options These services could be provided as part of the BC Medication Review Clinical Service, which allows a community pharmacy to be compensated by BC PharmaCare for performance of a medication review and/or a follow-up review by a Pharmacist.
    • Initial Renal Team Meeting • The IH Renal Penticton-based leadership team fully supported the idea of using this opportunity (and the external funding source) to provide medication reviews by the contract pharmacy at the PIHC
    • Project Purpose • To improve the quality of chronic kidney disease (CKD) care at the Penticton Integrated Health Centre (PIHC) through the integration of BCPRA-contracted pharmacy services with the multidisciplinary services currently in place.
    • How to Improve Patient Care • Participation as a dedicated member of the patient’s health care team • Higher level of communication between healthcare team members that improves efficiencies, effectiveness and patient care • Access to patient diagnosis and lab values to be able to effectively evaluate ALL medications and provide other healthcare team members with appropriate medication recommendations. • Bring a different set of skills to the team that is unique to community pharmacy that can compliment the expertise of the hospital pharmacists not duplicate it!
    • The Clinic • The CKD clinic regularly runs 1-2 days per week at the PIHC and 12 to 14 patients are scheduled to see a number of health care practitioners from the interdisciplinary team, which include: 3 rotating nephrologists; 2 registered nurses; 2 rotating pharmacists; 1 dietitian; 1 clerk; and, 1 manager • Pharmacist met with the patient for an average of 13 minutes after the nurse and before the nephrologist • to perform an interview, a medication history, identify any discrepancies and drug related problems, provide patient medication education and communicate findings to the team.
    • Pharmacist Process
    • Pharmacist Process
    • Pharmacist Process After Clinic ( 10 minutes – per patient) • Billing • Documentation • Filing
    • Quantitative Data Results • The 3-month project formally conducted from November 9, 2011 to February 8, 2012
    • Drug Related Problems • Total of 228 DRPs identified
    • Patient Experience • To evaluate the impact the project had on the patient, telephone surveys were administered • Overall, patients reported a positive experience when seeing the pharmacist at their last clinic visit (83%; 15/18). Several of these patients appreciated having the pharmacist go through their medications and explain them; a few others liked having the opportunity to ask questions about their medications.
    • Multidisciplinary Team Experience All team members (10/10) reported they felt the pilot project was improving patient care. Interdisciplinary team member experience with the pilot project was investigated using one-on-one interviews. A number of key themes emerged from several open- ended questions related to team member experience with patient care and professional impact.
    • Communication Improvement Team members also reported improved communication between clinic and pharmacy; that is, less inquires for clarification about prescription changes and medications in general from other community pharmacies to the clinic. Resulting in improved time-management for team members and pharmacy staffs.
    • Process Map
    • BC Kidney Days Award
    • Health Employers Association of British Columbia (HEABC) 2013 Collaboration Award of Merit
    • Contact Information • Greg Wheeler gregwheeler@shaw.ca Skaha Pharmacy-(250)493-8155 Cell Phone (250) 486-5852 • Other community pharmacists involved in project: Meghan Highley- Skaha Pharmacy Travis Petrisor- Skaha Pharmacy
    • What has happened since? • IH Renal Program has continued to utilize this model • Ongoing in Penticton • Expanded to: • Kamloops • Trail • Cranbrook • Preparing to trial the model in post-transplant renal clinic
    • Pros and Cons • Pros • Pharmacist becomes a member of the multi-disciplinary team • Provides pharmacy lens to areas without HA pharmacy presence • Increased clinical satisfaction for pharmacist • Cons • Dependent on BC Med Review program • Requires time commitment from community pharmacist • Consistency of process