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Presenting Author: Dr Ian Williams
Co-Authors: Mr Christopher Freeman
Mrs Jan Chaffey
General Practice / Pharmacist
Patien...
RACGP Clinical Guidelines
 To manage chronic illness
effectively requires
 Well co-ordinated patient centred care
that i...
Have you ever considered having a
Clinical Pharmacist work in your practice?
 I hadn’t until I visited a rural
practice t...
Why leave pharmacists in the
pharmacy?
 In our practices we already work with
other disciplines
 Registered and enrolled...
Guidelines for patients who may benefit from
a Home Medication Review
 Currently taking 5 or more medications
 Taking mo...
Case study of 85 year old lady with
intractable nausea and vertigo
 3 month history of intractable nausea
 Complicated M...
Medications at time of review
 Akineton
 Arthro aid
 Avapro
 Brufen
 Marevan
 Moduretic
 Murelax
 Oroxine
 Panade...
Pharmacist Recommendations
 Unknown to the General Practitioner
Digoxin had been commenced two
months earlier by the card...
Advantages of a Home Medication Review
performed by a practice based pharmacist.
 Timeliness
 Patient centred
 Access t...
Possible future roles of a Practice
Based Pharmacist
 Home Medicines
Review
 Residential
Medication
Management
Reviews
...
Possible future roles of a Practice
Based Pharmacist
 Management of services / systems to
ensure medication safety on a
p...
The Business Case for a
Pharmacist in the Practice
 In Development
 The Economic Value of Home Medicines Reviews
( VALME...
Questions?
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General Practice / Pharmacist Patient Centred Integrated Care

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General Practice / Pharmacist Patient Centred Integrated Care

  1. 1. Presenting Author: Dr Ian Williams Co-Authors: Mr Christopher Freeman Mrs Jan Chaffey General Practice / Pharmacist Patient Centred Integrated Care A model to consider
  2. 2. RACGP Clinical Guidelines  To manage chronic illness effectively requires  Well co-ordinated patient centred care that is:  continuous,  comprehensive,  and consistent
  3. 3. 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?
  4. 4. 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
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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.
  12. 12. 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.
  13. 13. Questions?

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