Summary of the example
This collaborative project between Newcastle-upon-Tyne NHS Foundation Trust, North of Tyne Local Pharmacy Committee (LPC) and Pinnacle Health Partnership LLP (provider of PharmOutcomes) involved creation of new hospital and community pharmacy referral templates within PharmOutcomes to facilitate a secure method of electronic transfer of information related to medicines between two hospital sites and 207 community pharmacies. The community pharmacy provides a follow-up consultation tailored to the individual patient needs.
Project outcomes were evaluated in July 2015 after 13 months, during which 2,029 inpatients were referred, 31% of these patients participated in a follow-up consultation by their community pharmacist. 47% of referrals had been rejected by community pharmacies for a variety of reasons.
Most referred patients were over 60 years of age and were referred for a Medicines Use Review (MUR) or enrolment for the New Medicines Service (NMS). Those patients who received a community pharmacist follow-up consultation had statistically significant lower rates of readmission and shorter hospital stays than those patients without a follow-up consultation.
Why we think it’s important
It has already been demonstrated that medicine adherence can be poor in patients prescribed a new medicine by a GP for a chronic medical condition. This can result in deterioration in health and a significant economic burden to the NHS. A community pharmacist follow-up has been shown to improve adherence.
This work identified patients in the hospital setting with changes to their medicines that it was considered would benefit from ongoing help with their medicines after they left hospital. While all identified patients received counselling from a pharmacist or a pharmacy technician before leaving hospital it was unclear how beneficial additional ongoing follow up from a community pharmacist would actually be.
Learn more about the example
Aims and objectives of the work
The aim of the project was to evaluate an electronic patient referral system from one UK hospital Trust to community pharmacies across the North East of England.
- To assess the number of referrals made to and received by different types of pharmacies, including the reasons for referrals.
- To assess which referrals were accepted/completed and rejected and their timeliness.
- To analyse the reasons for rejections by community pharmacists.
- To evaluate the details of the follow-up consultations.
- To review readmission rates at 30, 60 and 90 days post referral and compare hospital bed days for referred/not referred patients readmitted.
Clinical pharmacists and pharmacy technicians across the two hospital sites identified inpatients who, in their clinical judgement, would benefit from on-going support and continuity of care via a follow-up consultation with a community pharmacist. These included patients who:
- were on four or more medicines
- had a number of medicines changed during their hospital stay.
Patients were approached, informed about the service, and asked if they would like to participate and nominate a community pharmacy of their choice. At discharge a pharmacy technician or clinical pharmacist would:
- Log into PharmOutcomes.
- Populate various patient demographic fields including: name; date of birth; postcode; ethnicity; NHS number; GP details.
- Select a community pharmacy (nominated by the patient) from a drop-down list .
- Recommend what additional pharmaceutical service, advice or general care might be useful for the patient at the follow-up consultation (‘Reason for referral’ field).
- Add contact details of the member of staff making the referral.
Community pharmacists participated on a voluntary basis and were required to access their PharmOutcomes records regularly (every day) to check for referrals which they were required to ‘accept’ and commence actioning; ‘reject’ and provide a reason or ‘complete’ if actioned. In all cases pharmacists had to contact the patient to assess the need for or type of follow-up intervention. Depending on patient response a variety of pharmaceutical advice and services were provided e.g. MUR, NMS, stop smoking service, medicines reconciliation, review of a compliance aid. All activities provided to the patient were recorded in PharmOutcomes.
Service evaluation was between 1st July 2014 and 31st July 2015 (13 months).
- 2,029 hospital inpatients consented to participate.
- 98% of referrals were generated by pharmacy technicians.
- ~156 referrals were made each month to 207 community pharmacies (~0.75 referrals per month per pharmacy).
- 56% community pharmacies accepted referrals within 7 days of receipt.
- 45% of referrals were rejected by community pharmacies.
- 74% received information on their condition. The majority of patients followed up had a cardiovascular or respiratory disease.
- 90% patients received information on their medication:
- 88% on dose
- 84% on occurrence of side effects.
- 74% did not report an ADR to the community pharmacist but in the 17% who did the ADR was considered manageable and non-harmful to the patient.
- 47% received an MUR.
- 39% received an MUR and/or were enrolled on the NMS.
- 53% patients did not receive any additional pharmaceutical support/service.
The majority of referrals went to pharmacy multiples (52%), fewest went to supermarkets (6%). Multiples completed the highest percentage of referrals (38%).
In the year between 1st July 2014 and 30th June 2015, 501 (36%) patients had a completed follow-up consultation by a community pharmacist:
- Readmission rates were higher among those who did not receive a follow-up consultation:
- 0 to 30 days – 8% consultation vs. 16% no consultation
- 31 to 60 days – 4% consultation vs. 9.5% no consultation
- 61 to 90 days – 6% consultation vs. 9.4% no consultation
- Among readmitted patients, average duration of hospital stay was at least 5 days less for those who received a consultation.
Further details of the project have been published, see the link below.
National guidance, data and publications
The continuity of patient care is a national priority with NICE and the RPS issuing guidance on best practice. Links to further guidance and background are below.
Assistant Director, Lead pharmacist for Dental Medicines Information and Pharmacovigilance, North West Medicines Information Centre