Primary Health Care Development and Pharmaceutical Family Practice

1. 1
Pharmacist provision of primary health care: a modified Delphi validation of
pharmacists’ competencies. Kennie-Kaulbach et al. BMC Family Practice 2012, 13:27.
http://www.biomedcentral.com/1471-2296/13/27

2. Pharmacist
Medicines are the most
common healthcare
intervention, but:
–30-50% not taken as
intended
–4-5% of hospital
admissions due to
preventable adverse
effects of medicines 2

3. -
3

4. 4

5. 5

6. The NHS Community Pharmacy
Contract
• Essential services
–offered by all pharmacies
• Advanced services
–optional
–accreditation requirements
• Locally commissioned services
6

7. Essential services
• Dispensing
• Repeat Dispensing
• Support for self-care
• Signposting patients to other
healthcare professionals
• Healthy Lifestyles service
(Public health)
• Waste medication disposal
• Clinical governance

8. Advanced services
1. Medicines Use Review
(MUR) and Prescription
Intervention Service
2. Appliance Use Review
3. Stoma Appliance
Customisation
4. New Medicine Service

9. Locally Commissioned Services
• Minor ailments service
• Emergency Hormonal
Contraception
• Care home service
• Stop smoking
• Needle & syringe
exchange
• Monitored dosage
systems
• NHS Health Check
• Supervised
consumption
• Contraception
• Chlamydia screening &
treatment
• Other sexual health
screening
• Palliative care

10. Locally Commissioned Services
• Vaccination (influenza etc.)
• Alcohol screening and brief interventions
• Weight management
• Falls reduction
• Independent and Supplementary prescribing

11. Optimising the use of
medicines
Supporting
people
to self-care
Supporting people to
live independently
Supporting people to live
healthier lives/public
health

12. 1.
1.1 diabetic
1.2 osteoporosis
1.3 hypertension
1.4
COPD/Asthma
1.5
1.8
1.9 dyspepsia
2
dose administration
drug use review
2.3 food-drug-drug interactions
2.4 adverse product reactions
2.5 drug expired &
2.6 drug compliance
STI , VCT
3.2 FP,
3.3
3.4
Prevention and
Promotion (P&P) UCS

13. Doctor visit I @
CUP
District Health
System
Unity Team
(UCARE)
Pharmaceutical care
(Health literacy )
-Medication therapy
review,
-Personal medication
record,
-Medication action plan,
-Intervention and
referral,
-Documentation and
follow-up
Health Needs
Assessment
, COPD ,
Epilepsy, DM, HT,
, CKD, etc.
Reduce poly - pharmacy
Increase medication adherence, Medication Reconciliation
Quality and Outcome
Framework

14. QOF: UK
Generic name
• Pay for
Performance
• Value Based
Purchasing
• P4P
Name in a specific context
• UK: QOF -> Quality and
Outcome Framework
• Australia: PIP -> Practice
Incentive Program
• New Zealand: ACP -> Advance
Care Plan
• German: DMP-P4P -> P4P for
Disease Management
Programs
• US: > 150 programs, mostly
pilot studies and researches

15. 4 QOF domains UK 2012 / 2013
• Clinical Domain: 96 indicators in 22 areas (Asthma; Atrial Fibrillation; Cancer;
Cardiovascular Disease - Primary Prevention; Chronic Kidney Disease; Chronic
Obstructive Pulmonary Disease; Coronary Heart Disease; Dementia; Depression;
Diabetes; Epilepsy; Heart Failure; Hypertension; Hypothyroidism; Learning
Disabilities; Mental Health; Obesity; Palliative Care; Smoking; Stroke and Transient
Ischaemic Attacks; Osteoporosis; and Peripheral Arterial Disease) worth up to a
maximum of 669 points
• Organisational Domain: 42 indicators in 6 areas (Records and Information
about Patients; Information for Patients; Education and Training; Clinical and
Practice Management; Medicines Management; and Quality and Productivity)
worth up to a maximum of 254 points.
• Patient Experience Domain: 1 indicator on Length of consultations
worth up to a maximum of 33 points.
• Additional Services Domain: 9 indicators in 4 areas (Cervical Screening;
Child Health Surveillance; Maternity Services and Contraceptive Services) worth up
to a maximum of 44 points.

16. 16
: 1000
(4 (3 )
1.2
1.3
-
OP
2.2
Q34_ . .
2.3
2.4
. ……………………………………
. ……………………………………
2.5 ………….
2.6……………
(2 )
3.2
3 4 ……………………………………
3 5 ……………………………………
QOF 2557

17. – Shopping List
1: PP
2.
-
2,9
0-2 3. 2,9,11
3-5
5. DTP5
3,6,9
2,4,9
*
8.
Comprehensive care
9. dT
1,2,7,8,9,10,11
8,11
12
2,9,10
10. *
11.
1,2,4,5,6,7,9,10,12
1, 2,5,4,7,8,9, 10,12

18. – Shopping List
1: PP
12. 2,9
13. 6,10,13

19. 2:
– Shopping List
1. HbA1c 1
2. HbA1c < 7% 58
3. 1
4. HT mmHg
5.
continuity of pharmaceutical care)
(
3,5
3,6,9
1,3,8,9,10
8,9
1,10
6.
7.
1,6,7,11,12
-

20. 2:
– Shopping List
9.
10.
-
-
-

21. – Shopping List
DHS 1.
IC Lab
2.
3. DHS
4. NP)
1,3,5,6,8,9,10
1,8,12
3,6,9,12
9,10

22. 4:
– Shopping List
1. 12
0-5 1.
2. 1 DTP3
1,3
12
1. 0-5 7
1.
2.
3.
Blinding cataract
12
9
9
1. STEMI
2. TB
3.
4. home ward
5.
6. Home Health Care
7.
3
2
2,8
1
7
2
1

23. – Shopping List
1.
2.
3.
4. 1
8
8,13
9,13
12
1.
2. ICF
3.
6
8
1
1.
2.
10
10
/
.
1.
2.
7
6
4

24. – Shopping List
1. PCA
2. PCA
2,
2
1,6
1. URI /
2. URI
AGE
12
9
DHS 1. DHS)
ODOP)
2. Famed
5
5
4

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