These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

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Wednesday, August 01, 2018: Deep Dive Pharmacy

This article was published on Pharmacy in Practice

https://pharmacyinpractice.scot/2018/08/01/pharmacists-are-important-members-of-the-multidisciplinary-team-in-scotland-says-rizwan-din/

The Govan SHIP (Social and Health Integration Project) was set up in 2015, centred on four ‘deep dive’ GP practices serving some of the most socio-economically deprived communities in Scotland. The Scottish Government wants SHIP to develop anticipatory and preventative approaches for people with particular health needs to try to reduce unscheduled care and keep them out of a hospital. At the start of this year, Rizwan Din was appointed to work as a clinical pharmacist across all the SHIP practices, as part of a team delivering a very person-centred service to people who often don’t prioritise their own health. He took some time out to tell Pharmacy in Practice about his role.

The SHIP project is about integrating health and social care services to provide seamless patient care. Traditionally the quality of the interface between health and social services was variable and, in some cases, poor. Patients under the care of both are often some of the most vulnerable and complex. They are at risk of deteriorating rapidly when things go wrong, for instance, if there is a lack of communication about changes to medication, leading to GP home visits, referrals to unscheduled care services or hospitals admission 

“By bringing together health and social care teams at monthly multi-disciplinary team (MDT) meetings, we’ve increased communication, which has led to improved patient care. I found that there were various members of the team who, as a pharmacist, I’d never had the opportunity to liaise with previously. This project allows us to work together to improve the patient’s journey and reduce the burden on GP time. 

“The project had been running for a few years without designated pharmacy support beyond our practice prescribing support pharmacists, who are doing a great job! I saw this as an exciting opportunity to work with my line manager to develop a unique service. And, as details of the new GMS contract were revealed, I see this project as something of a pilot for the new pharmacotherapy service. 

“The patients included in the SHIP project are referred by their GP or a member of the MDT. The fact that non-traditional methods were used to identify patients has meant many patients were included who might have been excluded using traditional methods like SPARRA. I have found the benefit of this first hand, doing important polypharmacy interventions with a number of patients who might have been too young or had too few medications to warrant a review normally. There is no typical SHIP patient. My patients range from vulnerable elderly couples, people with mental health issues and even children with safeguarding issues. The majority of patients are housebound, so almost 40% of reviews are carried out on home visits. A further benefit of the home visit is that I was able to see how the patient is managing their medication. Storage of medication is a common issue, with multiple medications stored around the house some of which are out of date. Compliance issues are identified and addressed during these reviews, and I have an opportunity to discuss patients’ symptoms at a time when they are not acutely ill. I also get the opportunity to address wider social issues. In one case, the main cause for concern for one of my patients was a housing issue and I was able to liaise with the appropriate member of the MDT to alleviate it. 

“Patients have found the polypharmacy reviews very helpful and they have commented that it helps them understand what their medication is for, and the review process helps them to take control of their own treatment. One of the main benefits of this review for patients has been the reduction in tablet burden due to de-prescribing. 

“As per the polypharmacy guidelines, if the risk of side effects is higher than the likely benefit of treatment then the conversation to de-prescribe can be initiated. Side effects of medication result in 9% of hospital admissions so I believe acting to lower side effect risk helps to lower hospital admissions. I also found that inhaler technique was particularly poor in the elderly hence a review offers an opportunity to re-visit inhaler technique and ensure the patient is on the most suitable inhaler based on their technique and ability, thereby reducing risks of exacerbations.

“It is early to realise the full impact of this input. However, patients and surgery teams have provided positive feedback about the pharmacy input into the service. I believe this project has re-affirmed that pharmacists are important members of the MDT and I see the pharmacist’s role is further integrated into the primary care team, which will allow the pharmacist to utilise their skill set fully.” 

Rizwan Din is leading a session on ‘Integrating Pharmaceutical Care in a Health and Social Care Integration Project’ at the Pharmacy Management National Forum for Scotland in Dunblane on 30 August. Registration is free for pharmacists here.