Trusts can integrate pharmacy into community care

The Care Quality Commission conducts an annual satisfaction survey for patients to rate areas of care patients have received from mental health NHS trusts.

In 2010 an East Midlands foundation trust identified, through the results of the survey, the need to improve their performance in involving patients in their own medication choices and their explanation and information distributed about medications and their potential side effects.

In addition to this, the Is the NHS becoming more patient-centred? report by the Picker Institute in 2007 used the results of 26 national patient surveys carried out in England to assess the quality of NHS care.

A number of areas highlighted in the report supported the implication that patients across the country have concerns about their medication.

The results showed:

• many patients want more involvement in decisions;
• patients want to be involved in medication choices;
• professionals give insufficient information about side-effects; and
• shared decision making is not widely practised.

Improving pathways

Worldwide trials of pharmacist interventions have been conducted to see how pharmacists can improve patient experience and medication adherence by being included in multidisciplinary teams and involved in medication decisions and information sharing.

The New ways of working for mental health pharmacists and other pharmacy staff report, published in 2007, outlines the vision for every mental health service to employ specialist mental health clinical pharmacists, and how they can become fully integrated members of multidisciplinary teams.

Central and North West London Foundation Trust received a Pharmaceutical Care Award in 2006 for their introduction of a pharmacist into their community mental health team. The outcomes improved patient satisfaction and reduced the number of hospital readmissions.

‘The main issue raised was how best to introduce the pharmacy service to the team’

In response to the CQC’s findings in 2010, and from the growing evidence base in support of pharmacist interventions in 2011, Northamptonshire Healthcare NHS Foundation Trust piloted a pharmacy service within their community mental health team to improve quality of patient care by supporting patients with their medication choices and providing information on side-effects.

The main issue raised in the consultation process was how best to introduce the pharmacy service to the team. Stakeholders in the project had to decide whether to embed the pharmacist into the team as a separate service – which could be accessed directly by patients and staff – or make the pharmacy service a specialised function to support a nominated consultant psychiatrist.

As this was a new service the demand and interest by service users was unknown so the decision was made for the pharmacist to work alongside a consultant psychiatrist, only seeing patients that had opted to see them following their initial consultation with the psychiatrist.

Piloting the pharmacist

Funding was then secured from within the trust for an existing trust employed pharmacist to work within the team for two four hour sessions per week for three months.

During the pilot period the pharmacist continued to be managed by the trust’s chief pharmacist.

Initially the uptake for appointments with the pharmacist was lower than expected and the steering group decided to offer the pharmacy service to a second consultant psychiatrist and an additional session to the rest of the team to book patients into.

‘Findings from staff interviews showed the pilot service was a welcome addition to the team as it provided an additional resource to outpatients’

The team welcomed the opportunity to have access to a pharmacist because they felt both the service users and themselves would benefit from this additional source of information and expertise.

Although the new service would require preliminary start-up costs, areas of cost savings were identified that have the potential to save the trust enough money to eventually make the role self sufficient.

The biggest area of savings was the reduction in hospital admissions through improved understanding of medications, which ultimately led to enhanced medication adherence.

The reduction of appointment time for psychiatrists was identified as another potential area of savings as they would no longer be responsible for explaining medication choices and side-effects.

This in turn would reduce waiting lists, allowing psychiatrists to see more patients in each session.

Evaluating outcomes

Evaluation of the pilot programme was conducted by the project team in partnership with the Leicestershire, Northamptonshire and Rutland Collaboration for Leadership in Applied Health Research and Care.

The collaboration is a National Institute for Health Research initiative aimed at supporting NHS organisations to conduct and use research evidence to benefit local services and improve patient outcomes.

Effectiveness of the pharmacy service was measured using patient experience and staff satisfaction data from interviews and standardised and bespoke questionnaires.

‘Patients found pharmacist consultations to be positive, empowering and educational’

Forty-three patients were seen by the pharmacist and analysis of the questionnaires and interview data revealed that the service users were satisfied overall with the service and appreciated the benefits of consulting a pharmacist, especially to discuss medication choices and the management of side effects.

Service users reported feeling more confident about taking their medication after the consultation and described it as positive, empowering and educational.

Highlight the contribution

Findings from the staff interviews showed that the pilot service was a welcome addition to the team as it provided an additional resource to outpatients. Benefits that the service brought to both patients and other mental health professionals were highlighted. The inclusion of the pharmacist made a difference by providing medication counselling and an educational role.

The pharmacist was able to assist patients and staff with a wide range of issues in relation to medication, including some very specific enquiries.

The average scores from the CQC’s community mental health survey showed that in 2010-11 there was an increase in Northampton’s average score for: purposes of medications (by 1.3), side effects of medications (by 0.6) and information about medications (by 0.3).

The trust’s chief pharmacist Michaela Cox sums it up by saying: ”The project has enabled us to highlight the many ways pharmacists can contribute to integrative and multidisciplinary working throughout NHS services to actively improve the quality of the services we deliver to our patients.

“The project will be used to support our review of pharmacy services to our community services within the trust.”

Rachel Lovesy is former CLAHRC Co-ordinator at Northamptonshire Healthcare NHS Foundation Trust, Dr Paul Sinfield is manager of the collaboration, and Lorraine Pollard is a researcher at Leicester University