adding additional pieces to the puzzle
DESCRIPTION
Presented at the Optimizing Medications Workshop in Vancouver by Mary Lou LesterTRANSCRIPT
Community Pharmacist Integration into
the PIHC Renal CKD Patient Clinic • In 2011, Greg Wheeler, from Skaha Pharmacy (the British
Columbia Provincial Renal Agency contract pharmacy in
Penticton), proposed enhancing services to patients of the
Penticton Integrated Health Centre (PIHC) chronic kidney
disease (CKD) clinic, by performing medication reviews at
the clinic.
Payment Options
These services could be provided as part of the BC
Medication Review Clinical Service, which allows a
community pharmacy to be compensated by BC
PharmaCare for performance of a medication review and/or
a follow-up review by a Pharmacist.
Initial Renal Team Meeting
• The IH Renal Penticton-based leadership team fully
supported the idea of using this opportunity (and the
external funding source) to provide medication reviews by
the contract pharmacy at the PIHC
Project Purpose
• To improve the quality of chronic kidney disease (CKD)
care at the Penticton Integrated Health Centre (PIHC)
through the integration of BCPRA-contracted pharmacy
services with the multidisciplinary services currently in
place.
How to Improve Patient Care
• Participation as a dedicated member of the patient’s
health care team
• Higher level of communication between healthcare team
members that improves efficiencies, effectiveness and
patient care
• Access to patient diagnosis and lab values to be able to
effectively evaluate ALL medications and provide other
healthcare team members with appropriate medication
recommendations.
• Bring a different set of skills to the team that is unique to
community pharmacy that can compliment the expertise
of the hospital pharmacists not duplicate it!
The Clinic
• The CKD clinic regularly runs 1-2 days per week at the
PIHC and 12 to 14 patients are scheduled to see a
number of health care practitioners from the
interdisciplinary team, which include:
3 rotating nephrologists; 2 registered nurses;
2 rotating pharmacists; 1 dietitian; 1 clerk; and,
1 manager
• Pharmacist met with the patient for an average of 13
minutes after the nurse and before the nephrologist
• to perform an interview, a medication history, identify any
discrepancies and drug related problems, provide patient
medication education and communicate findings to the team.
Pharmacist Process
Pharmacist Process
Pharmacist Process
After Clinic ( 10 minutes – per patient)
• Billing
• Documentation
• Filing
Quantitative Data Results
• The 3-month project formally conducted from November
9, 2011 to February 8, 2012
Drug Related Problems
• Total of 228 DRPs identified
Patient Experience
• To evaluate the impact the project had on the patient,
telephone surveys were administered
• Overall, patients reported a positive experience when
seeing the pharmacist at their last clinic visit (83%; 15/18).
Several of these patients appreciated having the
pharmacist go through their medications and explain
them; a few others liked having the opportunity to ask
questions about their medications.
Multidisciplinary Team Experience
All team members (10/10) reported they felt the pilot project
was improving patient care.
Interdisciplinary team member experience with the pilot
project was investigated using one-on-one interviews. A
number of key themes emerged from several open- ended
questions related to team member experience with patient
care and professional impact.
Communication Improvement
Team members also reported improved communication
between clinic and pharmacy; that is, less inquires for
clarification about prescription changes and medications in
general from other community pharmacies to the clinic.
Resulting in improved time-management for team members
and pharmacy staffs.
Process Map
BC Kidney Days Award
Health Employers Association of British
Columbia (HEABC) 2013 Collaboration
Award of Merit
Contact Information
• Greg Wheeler
Skaha Pharmacy-(250)493-8155
Cell Phone (250) 486-5852
• Other community pharmacists involved in project:
Meghan Highley- Skaha Pharmacy
Travis Petrisor- Skaha Pharmacy
What has happened since?
• IH Renal Program has continued to utilize this model
• Ongoing in Penticton
• Expanded to:
• Kamloops
• Trail
• Cranbrook
• Preparing to trial the model in post-transplant renal clinic
Pros and Cons
• Pros
• Pharmacist becomes a member of the multi-disciplinary team
• Provides pharmacy lens to areas without HA pharmacy presence
• Increased clinical satisfaction for pharmacist
• Cons
• Dependent on BC Med Review program
• Requires time commitment from community pharmacist
• Consistency of process