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Designing Pharmacy Services

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by

Meagan Draper

on 7 November 2017

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Transcript of Designing Pharmacy Services

Designing Pharmacy Services
Canterbury's response to the national Pharmacy Action Plan
A workshop was held in May 2016...
...to agree the way forward for a
local response
to the Plan.
4 design groups
Fail
Mental
Vulnerable
Chronic
Conditions
were established to progress the discussion
Chronic Conditions
Membership
Consumer with a chronic condition (Respiratory) -
Pauline Mohi
Maori & Pacifica Health CALD -
Ngaire Button
Pharmacist Hospital Clinical team -
Connie Takawira
Community Pharmacist -
Simon Church
Pharmacist MTA/PHO -
Mel Gamble
GP /Collaborative Care -
Dr Rosie Laing
Care Coordinator Riccarton Clinic -
Tracey Udell
Literacy/Population health -
Dr Lynley Cook
Community Respiratory Nursing Service -
Karen Willsman
Rural Integrated Services -
Carol Glover
CCPG Pharmacist -
Kathryn Snook

Pharmacy P&F -
Michael James
Pharmacy SLA Facilitator -
Koral Fitzgerald

Pharmacy Design Group
Frail Elderly
Membership
Pharmacist ARC MTA accredited/HOP Work Stream Chair-
Ginny Brailsford
Maori Community Pharmacist –
Brendon McIntosh
Aged Care –
Janet Lester
Community Geriatrician-
Val Fletcher/Michelle Dhanak/Jackie Broadbent
CNS Community Team Older Persons Health & Rehabilitation -
Judy Falls
Care Coordinator-
Tracey Udell
Palliative Care -
Wendy Pattemore
Consumer Caregiver-
Carol Evans
Pharmacist PMH-
Bevan Harden
General Practice –

Dr Martin Seers
Home Based Support Services-
Susan Bowness
Nurse Practitioner OPH-
Deb Gillon
Aged Care Advocacy Sector-
Simon Templeton
CCPG General Manager -
Aarti Patel
CDHB Pharmacy -
Michael James
CDHB Planning & Funding -
Nanette Ainge
CCN Pharmacy SLA Facilitator -
Koral Fitzgerald
Pharmacy Design Group
Mental Health
Membership
SMHS Clinical Director –
Dr Peri Renison
Collaborative Care Liaison -
Rebecca Muir
General Practice –
Dr Rebecca Nicolls
Consumer -
Dawn Hastings
Specialist Mental Health Clinical Nurse Specialist -
Jo Rea
Maori Community Pharmacist -
Brendon McIntosh
(Simon Church for two meetings)
Consumer -
Phil Hall
NGO Stepping Stones Trust -
Mike Douglas
IT/Consultant Nurse -
John Beveridge
NGO Addiction Services Odyssey House -
Nigel Loughton
Community Pharmacist -
Simon Murphy
&
Chris Chapman
Pharmacy Practice Qual Med –
Di Hare
CCN Pharmacy SLA Facilitator–
Koral Fitzgerald
CDHB Planning & Funding Team Leader –
Kathy O’Neil
&
Michael James

Pharmacy Design Group
Vulnerable Children
Membership
Pharmacist (e-meds) -
Linda Joe
Pharmacist Community -
Jacqui Lawson
Child Health Services -
Dr Rachel Clarke & Dr Bronwyn Dixon
Community Public Health -
Kerry Marshall/Gail McLauchlan (Maori Perspective)
Midwives -
Kate Nicoll
Rural -
Janetta Skiba
Public Health Nurses -
Patricia Connell
Child Health Advisory Council -
Carmen Street
CCPG General Manager -
Aarti Patel
General Practice -
Marie Burke
Primary Care -
Donna Ellen
CCN Child & Youth Workstream Facilitator-
Wayne Turp
Pharmacy CDHB Planning & Funding -
Michael James
CCN Pharmacy SLA Facilitator -
Koral Fitzgerald

Pharmacy Design Group
Each design group agreed a set of
principles
Common
principles were...
Elderly
Health
Children
Including family & care givers
That's easy to access
Integrated Care (& Communication)
Trusting & enabling health professionals
Working
together
for better care
Healthier
Lifestyles
How could current services
Patient stories framed the design thinking
Walking in the
Listen to me & my opinion
Can high user entitlements apply across all pharmacies?
patient's shoes
I want to speak to someone in my language
confidence that all my pills are necessary for me
This helped us shape our recommendations...
Mental Health
Chronic Conditions
Frail Elderly
Vulnerable Children
Enable seamless access to Pharmacy services through appropriate
communication and e-prescribing
for vulnerable children. Enabling access to medications through
any Pharmacy

Develop an
awareness campaign
that explains what the Pharmacist can do
Develop an
IT platform that addresses quality & risk issues
relating to patients being connected to multiple providers across the system
Develop an initiative that enables the
Pharmacist to be part of the care team
Develop a holistic
wrap-around enhanced service
for enduring mentally ill patients
Enable health screening, brief intervention & appropriate referral by community pharmacy for mental health patients when picking up medications
Target the uptake of
shared care plans
for mental health patients
Formalise a
specialist Pharmacist resource for mental health
in Canterbury
Develop an initiative enabling Pharmacists to be integrated into the patient's
care team
Advocate for an openly shared, appropriate
patient IT record
Investigate an initiative to
re-admit frail elderly back into the community
on discharge from hospital
Develop a gold standard where
Medicines Reconciliation occurs at every point of transfer
(home, hospital, ARC, etc)
Investigate an
enrolment scheme
targeted at patients with complex needs, with incentives for frail elderly to attend one pharmacy
Develop (or leverage off existing) core skills programme to
increase Pharmacists' knowledge of frailty
Develop a locally relevant, consensus-based
policy statement or decision tool for "appropriate prescribing
that is consistent with goals for care"
Promote Pharmacy's role in supporting frail elderly & their family with
self-management tools
Evaluate HealthInfo with a frail elderly lens
to support appropriate health literacy tools for use in Pharmacy
Leverage off the results of the SIAPO investigation into
interRAI as major predictor of ARC admission
as it relates to medicines management
Develop a
gold standard
for a 'patient centric' pharmacy environment
Investigate a
Pharmacy enrolment / registration service
, incl. incentives & reduce barriers to access
Integration between GP & Pharmacy
(either weekly time in general practice or shared chronic condition patient management)
Develop a
standard for Pharmacy environment
that clearly identifies where patients go for health advice & privacy
Develop a
training package & competency standards
relating to chronic conditions for Pharmacists
Formalise a
specialist pharmacist service
in Canterbury for community pharmacy to discuss complex medication regime
Develop a
public awareness campaign
communicating what pharmacists can do for people with chronic conditions
Develop an initiative to
improve rural access
to enhanced pharmacy services
Promote the Pharmacist's role in
supporting patients to navigate
health & community-based services
Investigate a role for
specialist Pharmacists in hospital outpatient clinics
Here's our recommendations:
Each design group
then considered the
key emerging themes
where enhanced or integrated Pharmacy services could have a positive impact on the outcomes of these special populations.
Support
Pharmacy leadership engagement with Specialist Mental Health Service / Canterbury Alcohol & Drug Service
management & leadership
Investigate initiative that
delegates responsibility for dose changes
in addiction services to Pharmacy
Develop an initiative that enhances the
Pharmacy environment to be culturally appropriate & accessible
for vulnerable children & their whanau
Develop a programme supporting Pharmacists to increase their
understanding of vulnerability
Promote the use of
HealthInfo
as a health literacy tool within Pharmacy & advocate for access to
multi-language info
Develop an initiative that leverages on the point of contact with the vulnerable child and their whanau, connecting them to their community and
enhancing the Pharmacist's role & skill as a health navigator & advocate
Promote the Pharmacist as an integral part of the
multi-disciplinary team
Advocate, enable & provide flexibility for
dispensing medications
to meet the family situation/needs
Enable the opening of permissions for
pharmacy to access & add to the patient record
(incl. an alert when information is added)
Enable parents access to their children's information via a
patient portal
Investigate an
electronic application process to access WINZ support
for children with chronic illness requiring unsubsidised interventions & treatment
The Vulnerable Children Design Group make these recommendations under the following
additional principles
:
Your culture doesn't necessarily make you
vulnerable
.
But you may become vulnerable if the service is not
culturally appropriate or welcoming
.
Reduced bureaucracy
is required to enable access for vulnerable children and their whanau to the medications they need.
A paradigm shift is required in Pharmacy

from a 'transactional' to a
'holistic' approach
.
Steps towards implementation
Implementation Plan drafted and prioritisation process applied.
Follow the developments nationally.
Draft priority timeframes and system/project leads identified.
The design groups worked towards a set of agreed
Articulate

implementable changes

that have a
positive impact
on the outcomes for people
Define processes
by which we can support an
integrated model

for people
Articulate the
role of Pharmacy
in
optimising access
to the right care, at the right time, by the right person
Describe
what it looks like when it's working
and
solutions to the barriers

that might get in our way
expected outputs:
you won't sell me stuff that isn't effective?
Chronic Conditions
Edna
I want to trust that I am getting the right medicine, especially after being discharged from hospital
Educate me about my medicines
Maylyn
Can I trust that
Piri
I want
Bob
Mayfeng
I need the
Pharmacy to come to me
Edna
Frail Elderly
Jack
I want a trusting relationship & continuity with my Pharmacist
Mary
John
What can
the Pharmacy
Mental Health
We need an advocate
Aroha & Sam
Mark & Baby Josh

over our medications in a private space?
Can my
Pharmacist hand
Ria & May
Vulnerable Children
be enhanced for these patients
The groups then considered...
enhanced Pharmacy services look like in different settings?
What could
HOME
PHARMACY
GENERAL PRACTICE
COMMUNITY CARE
RURAL
IT SYSTEMS
This led to...
The group wanted to
define / describe
what they mean by the Frail Elderly…
A spectrum which might include: reduced physiological reserves / low energy or fitness / social isolation (low mood) / impaired cognition/ poor nutrition / mobility impaired/ dehydration/ incontinence; multi-morbidities; risk of adverse reaction to stressor(s).
Threatened independence/ reduced cognition that impairs decision-making. Markers might include repeated unplanned admissions to hospital.
do for me?
such as...
Common Themes
Enhancing the Pharmacy environment
Pharmacy integrated with GP team
Shared IT platform
Stengthening the Pharmacist-Consumer relationship through an option to enrol at a Pharmacy
Pharmacist formalised as part of the MDT/IDT
Increase core skills of Pharmacists
Public awareness of what the Pharmacist can do
Consumers want to be in control of their care
Consumers want information that helps them make good choices about both self care and care offered by Pharmacists and others
Paper going to Pharmacy SLA for endorsement on 1st December.
Engagement commenced with system partners: Mental Health WS, Child & Youth WS and Health of Older People WS.
Recommended priorities
Enhancing the
Pharmacy environment

Public awareness campaign
communicating what Pharmacists can do for people

Formalising a
specialist pharmacy service
for chronic conditions and mental health patients

Advocating for a
shared IT record

Targeting uptake of
shared care plans
for mental health patients

Pharmacy leadership engagement with
specialist mental health and addiction services leadership

Supporting
health navigation and advocacy
by leveraging off the Pharmacist's point of contact with mental health patients and vulnerable children and their whanau

to start immediately
Pharmacy Enrolment/Registration
Pharmacy Environment
Core Skills Training
Public Awareness Campaigns
Specialist Pharmacist Service
CHRONIC CONDITIONS
MENTAL HEALTH
VULNERABLE CHILDREN
MENTAL HEALTH
CHRONIC CONDITIONS
CHRONIC CONDITIONS
FRAIL ELDERLY
CHRONIC CONDITIONS
VULNERABLE CHILDREN
CHRONIC CONDITIONS
FRAIL ELDERLY
VULNERABLE CHILDREN
CHRONIC CONDITIONS
VULNERABLE CHILDREN
Pharmacy Role as Health Navigator
FRAIL ELDERLY
CHRONIC CONDITIONS
VULNERABLE CHILDREN
Integration into the care team
FRAIL ELDERLY
MENTAL HEALTH
VULNERABLE CHILDREN
Shared IT Record
FRAIL ELDERLY
VULNERABLE CHILDREN
Health Literacy
Full transcript