Role of Clinical PharmacistFacilitators in Hawke’s Bay
Billy Allan – Chief PharmacistAnne Denton – Team LeaderBrendan Duck – CFP Totara HealthVanessa Brown – CFP Greendale Family Health/Taradale MedicalJenni Jones – CFP Hastings Health CentrePeter McIntosh – CFP Te Mata Peak PracticeDi Vicary – Population-based Pharmacist, Health Hawke’s Bay
Background
A collaboration between
DHB Hawke’s Bay
PHO Health Hawke’s Bay
GP practices
Why clinical pharmacist facilitation?
$200,000 year-on-year increase in combined pharmaceutical budget CPB = community pharmaceuticals
+ pharmaceutical cancer treatments
+ vaccines (from 1 July 2013)
Not sustainable
No ‘low hanging fruit’
Hawkes Bay pharmaceutical expenditure (12 month rolling totals)
Data source: Pharmac Drug expenditure report for DHB for year ending Sep-10
$1,500,000
$6,500,000
$11,500,000
$16,500,000
$21,500,000
$26,500,000
$31,500,000
$36,500,000
Feb-0
4A
pr-
04
Jun-0
4A
ug-0
4O
ct-
04
Dec-0
4F
eb-0
5A
pr-
05
Jun-0
5A
ug-0
5O
ct-
05
Dec-0
5F
eb-0
6A
pr-
06
Jun-0
6A
ug-0
6O
ct-
06
Dec-0
6F
eb-0
7A
pr-
07
Jun-0
7A
ug-0
7O
ct-
07
Dec-0
7F
eb-0
8A
pr-
08
Jun-0
8A
ug-0
8O
ct-
08
Dec-0
8F
eb-0
9A
pr-
09
Jun-0
9A
ug-0
9O
ct-
09
Dec-0
9F
eb-1
0A
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Jun-1
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0
12 months to
Aging PopulationItems Dispensed per Capita by Age
Comparison of dispensing rates by age group (items),
January to December 2010
0.0
20000.0
40000.0
60000.0
80000.0
100000.0
120000.0
0-14
years
15-24
years
25-44
years
45-64
years
65-84
years
85+ years Total (all
ages)
Rate
(cru
de)
per
1000 p
opula
tion
Haw ke's Bay New Zealand
Source: Pharmaceutical Claims Data Mart, Ministry of Health (Extracted: 22/4/2011). Note data subject to
change over time.
Aims
Interventions targeted at polypharmacy
≥ 65 years
Would not disadvantage Māori, Pacific or
NZDep 9/10
Polypharmacy
patient harm / ADRs
Fulton & Allen 2005
The model
Clinical pharmacist facilitators (3.5 FTE)
Focus on best practice – not cost
To complement the population based clinical pharmacist facilitator (1.0 FTE)
Medicines and Diagnostics
Funded by DHB working out of PHO
in specific practices
The Practices (at present)
Totara Health, Hastings and Flaxmere. Targeted population: patients with high needs including Māori and Pacific and NZ Dep 9/10.
Te Mata Peak Practice, Havelock North. Targeted population: High enrollment of patients living in ARRC.
The Practices (at present)
Greendale Family Health, Greenmeadows. Targeted population: high percentage of patients 65 years or older living in own home.
Taradale Medical Centre, Taradale. Targeted population: high percentage or enrollments aged 65 years or older.
The Practices (at present)
Hastings Health Centre, Hastings. Targeted population: over 65 years and high needs patients.
What do they actually do? (1)
Medicines Reviews
Medicines Therapy Assessments (MTA) With on going monitoring of
changes
Medicine reconciliation Discharge to home
Admission to ARRC
Targeted T2DM CVD risk reduction BP
LDL
HbA1c
Education Patients – including
adherence support
GPs
Practice nurses
ARRC staff
Adherence screening tool T2DM Undertaken at routine
Diabetes review by RN
What do they actually do? (2)
Medicine information queries
Falls reduction (vitamin D in ARRC)
MRFRAT
Bulletins digoxin, blood glucose
dabigatran
Cornerstone accreditation preparation Review of medicine policies
and standing orders
DUEs
Citalopram (QT)
Dabigatran (ClCr)
Oral methotrexate (monitoring and day of week)
The Triple Aim
The Population• Lowering of HbA1c• Lowering of blood pressure• Lowering of lipids• Greater adherence to medicines• Nurse run diabetes clinics with CP
advice available
The Individual• More appropriate medicine regimes• Less polypharmacy• Fewer falls• Fewer hospital admissions• Fewer ED presentations• Safer transition between services• Greater patient satisfaction
The System• Reduced cost of drugs • Fewer events / hospitalisations• Fewer rest home admissions • Fewer ADRs
Where to from here?
Plan is to have the equivalent of 8 FTE CPFs
Four new Clinical Pharmacists have been employed
Starting date 14.12.2015
Will be in GP practices January 2016
The team … so far…
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