World Pharmacists Day: Doctors and pharmacists working together to transform patient health
World Pharmacists Day is 25 September. To celebrate the Pharmaceutical Society talked to doctors and pharmacists about how they are working together to transform the health of patients in their communities.
Rheumatic fever throat swabbing programme
Dr Kate Grimwade, Infectious diseases specialist, Tauranga Hospital
The throat swabbing programme for prevention of rheumatic fever is a good example of how pharmacists and doctors are collaborating to improve health outcomes for patients.
This is a programme I have been involved with recently in collaboration with local pharmacists in the Bay of Plenty area. The programme enables pharmacists to take a throat swab, and give antibiotics, or refer patients to a doctor if required.
The programme was stimulated by local pharmacists who recognised this was an issue in their community. They saw this programme was working in Northland and Waikato and approached doctors at the infectious diseases service and asked us to be the clinician support for the programme.
Pharmacists can help reduce barriers to healthcare in the community. Making it possible for patients to access healthcare services through pharmacists, as well as GPs, is one way we can remove barriers to accessing healthcare, particularly for high-risk populations.
Pharmacists working in general practice
Dr Andrew Miller, general practitioner, Northland
We had a clinical pharmacist who worked part-time in our medical centre, funded by the Northland District Health Board (DHB). He went with one of our doctors on her ward rounds in an aged residential care facility. In Northland, we have a very vulnerable population on lots of medications. He did medication reviews on over 100 patients. After he finished doing those reviews there was not one medication related fall. He also carried out his own ward rounds and fed back to our doctor things of concern.
Our clinical pharmacist also carried out clinical audits. For instance, he looked at everyone who was on long-term prednisone and highlighted their need for bone strengthening medication.
We were very comfortable with his clinical skills. He looked through things that are clearly evidence based and recommended what we should be doing. He left Northland and the DHB have not replaced him and we feel this was a big loss to our team.
We should have a full-time clinical pharmacist in our practice. Our practice has over 11,500 patients. A clinical pharmacist would pay for themselves in terms of adverse drug reactions, long-term conditions management, accurate dosing for renal function, and de-prescribing unnecessary medication. This would reduce admission rates to hospital and is obviously better for patients, who would be taking less medication and having less side effects. Pharmacists do medicines better than doctors and we should be enabled to work together as one team.
Hospital medication management
Di Wright, Paediatric and clinical advisory pharmacist, Taranaki Base Hospital
In our hospital setting, pharmacists are out on the wards collaborating with doctors each day.
For example, in Taranaki Base Hospital pharmacists manage the therapeutic drug monitoring for any patients on three antibiotics called gentamicin, tobramycin and vancomycin. up. As a prescribing pharmacist, I prescribe medication as well within my scope of practice (paediatrics).
For instance, we had a child with cystic fibrosis admitted who needed two weeks’ worth of intravenous antibiotics.
If possible, we like to manage these children in the community, so they are at home, rather than in hospital. The doctor said to me “Can we have your help to get the antibiotics sorted so we can get this child home.”
Once a discharge date was established with the doctor, I prescribed the antibiotics for discharge, facilitated their supply (one needed to come in a specially made infusor device from Auckland), put in place a plan for blood level monitoring of one of the antibiotics and was the person responsible for reading (and if necessary acting on) the results.
Susan Donaldson, community pharmacist, Hastings
Doctors often refer their warfarin patients to pharmacists to manage their International Normalised Ratio (INR) blood tests and warfarin doses. This is a collaborative care model where the pharmacist is working to a standing order from a general practitioner.
This is much more convenient for the patient, because instead of travelling to the laboratory for a venous blood test, their local pharmacist can measure INR levels using just a small sample of blood from a gentle finger prick.
The test results are available immediately, which means the pharmacist can modify the warfarin dose straight away, without delay. This also saves time for GPs and practice staff, as there’s no need to phone patients with their test results.
Widening the access for warfarin patients to have their INR testing done at their local pharmacy would make a big difference in our community. Currently, selected pharmacies are funded by their local DHB to provide INR blood testing for a maximum of 50 patients. But I know pharmacists who say they could help a lot more than 50 patients.
Kiri Ora skin programme
Leanne Hall, pharmacist, Bay of Plenty Community Pharmacy Group
Another area where pharmacists and doctors are working together to improve health outcomes for the community is the Kiri Ora skin programme.
Parents will often turn up at their local pharmacy with children who have minor infections and infestations, such as scabies, head lice, boils and impetigo. These are conditions that can be recognised and diagnosed by trained pharmacists and then treatment provided by the pharmacist, without any cost to the patient.
The Kiri Ora skin project has been a collaborative project between the Bay of Plenty community pharmacy group, GPs and District Health Board specialists. We have worked together to formulate a manual and standing order that doctors and pharmacists are happy to work with. Red flags are highlighted for referral to GPs and also GP triage can refer back to pharmacy if they can’t get a child in for a GP appointment with a minor skin infection or infestation. The GP gets a copy of all consults too.
For the Kiri Ora skin programme pharmacists worked together with specialists and GPs to get feedback as to how pharmacists could contribute to minor skin infections and infestations. Most doctors were very supportive as they see it as breaking down the barriers of inequality and making medicines accessible to all.
Improving health outcomes for patients
The doctors and pharmacists interviewed all agreed there would be advantages from more pharmacists working in general practice teams to provide an integrated one-team approach to primary health care for patients.
As pharmacist Di Wright explains, “We already have a shortage of GPs in New Zealand, so it’s about working together and helping each other get the best health outcomes for patients.”
“If you’ve got two lots of expertise (a pharmacist’s and a doctor’s) going into managing patients in that practice… that should result in improved health outcomes for the patients."
According to general practitioner, Dr Andrew Miller, “If doctors and pharmacists had shared funding, shared technology systems (e.g. patient information and medication lists), and shared planning of care that would make the whole system more patient-centric and more team based.”
“Pharmacists do medicines better than doctors, and we should be enabled to work together as one team.”