The document summarizes an ongoing project called IPAC that aims to integrate pharmacists within Aboriginal Community Controlled Health Services (ACCHS) to improve chronic disease management. The project is a collaboration between NACCHO, PSA, and JCU. It involves placing pharmacists at 22 ACCHS sites across Australia to provide services like medication reviews and education. Initial data shows over 150 patients enrolled with various services provided. The project aims to measure improvements in health outcomes, prescribing, and cost-effectiveness through 2021.
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Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and a...NHS Improvement
Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
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Guoman Tower Hotel, London
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•Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
•Suggest that primary care take on a leadership role in medication safety ‐ we can (and should!) "own" the list.
•Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.
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Follow our social media accounts:
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PCMH implementation, highly associated with important outcomes for both patients and providers. The rate of emergency department visits was significantly
lower in sites with more PCMH effective implementation. Efficient PCMH implementation favorably associated with patient satisfaction, staff burnout, quality of care, and use of health care services.
Medicines optimisation, pop up uni, 9am, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
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The purpose of this call is to learn how the Department of Family Medicine at Queen’s University was able to:
•Raise awareness about medication safety issues ‐ specifically medication reconciliation in primary care.
•Highlight the need for better communication and connectivity between hospitals, pharmacies, and primary care. (And how we can help each other.)
•Suggest that primary care take on a leadership role in medication safety ‐ we can (and should!) "own" the list.
•Stress the importance of medication reconciliation as a continuous, interdisciplinary, and collaborative activity.
How Can Hospitals Improve Their Patient Referral Management By Complying With...GaryRichards30
FQHCs prefer working with EMR/EHR systems because they are comfortable with it. So they do not wish to move out their EHR/EMR system. An EHR/EMR system has many advantages but when it is complemented with a Referral Management software practices can experience many more benefits.
How great it would be if a Patient Referral Management software could integrate seamlessly with an EMR/EHR system? It can help in ensuring end-to-end Patient Referral Management without disturbing the existing system.
Please share these slides with anyone who may be interested!
Watch all our webinars: https://www.youtube.com/playlist?list=PL4dDQscmFYu_ezxuxnAE61hx4JlqAKXpR
In this webinar:
● A discussion on how new treatments are reviewed and approved for sale in this country, with a particular emphasis on Health Canada’s regulatory modernization initiative
● Explanation of patient involvement in Health Canada reviews as well as the special access program.
View the video:
Follow our social media accounts:
Twitter - https://twitter.com/survivornetca
Facebook - https://www.facebook.com/CanadianSurvivorNet
Pinterest - https://www.pinterest.com/survivornetwork
YouTube - https://www.youtube.com/user/Survivornetca
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• Biostatistics Services is important for collecting, reviewing, presenting, and interpreting data in clinical research.
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
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FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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NACCHO 2018 National Conference – Project Reference Group Meeting
1. Integrating Pharmacists within ACCHSs to improve
chronic disease management
(IPAC) Project
Dr Deb Smith and Dr Erik Biros on behalf of the IPAC Project Team
NACCHO Members Conference, Brisbane, 1st November 2018
2. Pharmaceutical Society of
Australia
National Aboriginal Community
Controlled Health Organisation
College of Medicine and Dentistry,
James Cook University
Contract signatory with the
Department of Health. Primarily
responsible for pharmacist
recruitment, training, and support.
Partner responsible for
coordinating contracts,
relationships and
operations involving ACCHSs and
Affiliates. Facilitates project
governance and leadership.
Partner responsible for trial design
and the coordination of project
evaluation and analysis of process,
outcome, and economic
evaluation.
Ms Deb Bowden Dr Dawn Casey;
Mr Mike Stephens
Associate Professor Sophia Couzos
Project Partners
3. Project Sponsor
The financial sponsor of this Project is the Australian Government Department of Health, under
the Pharmacy Trials Program (Tranche 2) funding as part of the 6th Community Pharmacy
Agreement (6CPA).
The 6CPA is a five-year agreement (to June 2020) between the Commonwealth of Australia (as
represented by the Department of Health) and the Pharmacy Guild of Australia.
4. Project Objective
• To explore if quality of care outcomes for Aboriginal and/or Torres Strait Islander adult patients
with chronic disease can be improved by integrating a practice pharmacist within the primary
health care team of Aboriginal Community Controlled Health Services (ACCHSs), when compared
with prior care.
Expected Outcomes
• Improved chronic disease outcomes;
• Improved prescribing by doctors;
• Improvements in health service activity related
to medicines use;
• Cost-effectiveness analysis.
Members of the Steering Committee and Project Operational Team.
5. Project Outcome Measures
• Primary outcomes:
• improvements in quality of care outcomes (biomedical measures such as BP, HbA1c, lipids, CV risk
assessment (levels and risk) in patients with chronic disease.
• Secondary outcomes:
• improvements in other quality of care outcomes:
• Prescribing indices (Medication Appropriateness Index, measures of overuse, and assessment
of underutilization of medicines)
• Home medication reviews (HMR) (MBS 900 claims), and other medication reviews (‘non-HMR’
and ‘follow-up to a non-HMR’)
• Health service utilisation indices (MBS items 721, 723, etc)
• Patient survey scores for adherence and ‘reasons for non-adherence’
• Patient and stakeholder perceptions (ie ACCHS staff, IPAC pharmacists, community pharmacy)
• cost-effectiveness analysis
7. Study Design and Intervention
• Interventional, pragmatic, non-randomised, pre and post study with a cost-effectiveness analysis,
where the pharmacist intervention will be added to standard primary health care practice within
ACCHSs.
• Adhering to community-based participatory research (CBPR) principles.
• Pragmatic trials seek to determine if interventions work under usual conditions rather than under
ideal conditions - vital for the generalisability of the project.
• Registered practice pharmacist integrated within the primary health care team of an ACCHS
• 15-month intervention period (aggregated to represent 0.57 FTE pharmacist per site)
• Up to 22 ACCHSs in Queensland, Northern Territory, Victoria
• Sites geographically spread (urban, regional, remote)
8. Project Timelines
3 phases:
• Establishment phase – ethics, site recruitment, pharmacist recruitment
• Implementation Phase - started in August 2018 (15 months)
• Analysis and Reporting - final report due April 2020
2017
Dec Jan Feb March April May June July Aug Sept Oct Nov Dec Jan Feb March Apr May June July Aug Sept Oct Nov Dec Jan Feb March April May
ESTABLISHMENTPHASE IMPLEMENTATION PHASE ANALYSIS AND REPORTING PHASE
Tranche 1: 6 pharmacists commenced onsite
Tranche 2: 8 pharmacists commenced onsite
Tranche 3: 5 pharmacists commenced onsite
Tranche 4: 3 pharmacists scheduled to commence
2018 2019 2020
9. Pharmacists 10 Core Roles
• Medication Management Reviews
• Team-based collaboration
• Medication adherence assessment & support
• Medication Appropriateness Index and Assessment of Underutilisation
• Preventative health care
• Drug Utilisation Review
• Education and training
• Medicines information service
• Medicines stakeholder liaison
• Transitional care
Patient -
related activity
Practice - related
activity
(health professionals
& systems)
10. Patient Inclusion Criteria
• Aged 18 years of age and over with:
• Cardiovascular disease (coronary heart disease, stroke,
hypertension, dyslipidaemia and any other CV disease),
• Type 2 diabetes mellitus,
• Chronic kidney disease,
• Other chronic conditions at high risk of
developing medication- related problems
(e.g. polypharmacy).
• Patient consent is required
• All patient data is de-identified
• Promotional material developed
11. Health Systems Assessment
Section Characteristic
A General characteristics of IPAC sites (eg size, location, etc)
B FTE Staff employed (doctors, nurses, AHWs, etc)
C FTE Allied health employed and type
D Access to allied health in the local community (eg average drive-time)
E Access to specialists in the local community (eg average drive-time)
F Community engagement (pharmacy, hospitals, other partnerships?)
G Other engagement (research, Healthcare Homes, CQI partners)
H Quality of communication with hospital system, specialists, PHNs
I Quality of communication with community pharmacy
J Care planning
K Systems for clinical management and chronic disease care
L Resources used routinely
M Economic characteristics of the service
12. Pharmacists Logbook
• Unique domain name www.ipac.net.au
• Secured, only pharmacists and project partners can access
• Custom built data entry and real-time data management system
developed for JCU (Copyright: Commonline Pty Ltd)
• Data source for JCU evaluation
• Pharmacists enter data
• Assists IPAC Pharmacists to manage their activity
• PSA can audit and track pharmacists activity
• Simple to use
13. GRHANITE TM
• Pharmacists have full access to clinical information systems (CIS)
• JCU subcontracted the Research Information Technology Unit, Faculty of Medicine, Dentistry &
Health Sciences, Melbourne Medical School, at the University of Melbourne to use the GRHANITE
data extraction tool from two CISs (Best Practice and Communicare)
• Associate Professor Douglas Boyle (developer) is a member of the JCU evaluation team
• Minimally intrusive, pre-programmed, automatic, weekly extraction in Microsoft SQL format
• Data is extracted ONLY from consented participants (opt-in)
• Only ethics approved data is extracted
• Data is de-identified
14. Qualitative Measures
• General analysis – HSAs and Pharmacist Logbook
• Site Visits - Sites can nominate now! Close on 23rd November 2018.
• 3 sites in total - one in each jurisdiction (Qld, Vic and NT)
• Qualitative researcher/s will attend on site for 3-4 days (June-October 2019)
• Data collection activities will be undertaken with:
• the IPAC pharmacist (in-depth interview and observation for a day)
• site staff (focus group and/or interviews)
• patients (focus group and/or interviews, including one in-depth interview).
• Remote data collection using technology
• interviews with IPAC pharmacists not involved in the site visits
• online survey for GPs within the IPAC sites and local community pharmacists
15. Current Status
• GRHANITE site acceptance testing completed for Best Practice and Communicare, installations
now being rolled out in all ACCHSs
• First patient recruited, 9th August 2018!
• 150 patients recruited at baseline
States Number of
ACCHSs involved
Sites Pharmacists
contracted
PSA
employee
Community
pharmacists
Northern Territory 6 8 5 3 4
Queensland 7 9 9 7 2
Victoria 6 7 7 7 0
TOTAL 19 24 23 17 6
21. Health System Assessment – Baseline Data
1
2
3
4
5
6
7
8
9
10
Delivery system design
Links with community,
other health services and
other services
Organisational influence
and integration
Information system and
decision support
Self-management support
Figure 1: One21seventy systems assessment scores
22. IPAC Logbook – Baseline Data
PATIENT LEVEL SERVICE NUMBER
No of patients who have
received each service:
N-MARS 145
HMR 12
Non-HMR 13
Follow-up to either HMR or non-HMR 5
MAIs 23
AOUs (from MAI, HMR and non-HMR) 32
Education and Training – written information for patients 1
Education and Training – conducted workshop (patients/community) 1
PRACTICE LEVEL SERVICES NUMBER
No of events:
Education and Training – written information for the clinic 2
Education and Training – participated in workshop 2
Education and Training – conducted workshop (staff) 1
Team-Based Collaborations 57
Drug Utilisation Reviews 0
Medicines Information Services 68
Stakeholder Liaison – Contacts with Community Pharmacy 120
Stakeholder Liaison – Liaison Plans developed 0
Transitional Care 17
24. For Further Information:
NACCHO
• Ms Fran Vaughan – Project Coordinator: Fran.Vaughan@naccho.org.au
• Ms Alice Nugent – Project Coordinator: Alice.Nugent@nacho.org.au
PSA
• Ms Hannah Loller – Project Manager: Hannah.Loller@psa.org.au
• Ms Megan Tremlett – Project Manager: Megan.Tremlett@psa.org.au
JCU
• Dr Deb Smith - Project Manager: Deb.Smith@jcu.edu.au
• Dr Erik Biros - Biostatistician: Erik.Biros@jcu.edu.au
• Assoc Prof Sophia Couzos - Evaluation Lead: Sophia.Couzos@jcu.edu.au
Editor's Notes
Based on FTE pharmacists and size of the practice:
0.2FTE pharmacist base allocation and a proportional allocation related to the total number of patients/site
Total of 12.54 FTE pharmacists (all sites) for 15 months (for an average of 0.57 FTE per site)
Target of 4 patients/day/1.0 FTE first 4-5 months (phase 1) of implementation phase, with follow-up conducted in the remaining 10 months (phase 2).
Estimate ~5000 patients.
