European Community Pharmacy Blueprint A perspective from general practice Professor Tony Avery

Outline of presentation Focus on improving treatment outcomes Prescribing problems in general practice Strategies for improving patient outcomes –Managing medicines and empowering patients –Making best use of IT –Collaborative care –Ensuring continuity of pharmaceutical care

Prescribing problems in general practice GMC PRACtICe study of the prevalence, nature and causes of prescribing errors Preventable drug-related hospital admissions studies Other studies

GMC-funded PRACtICe study Prescribing or monitoring errors detected in: –1 in 20 prescription items –severe errors in 1 in 550 items Most common types of error were inadequate dose instructions; dose/strength errors, and failure to undertake blood test monitoring Risks increased in young, elderly, those on multiple medicines and those taking ‘high-risk’ medicines GPs take prescribing safety seriously, but multiple causes of error were found relating to: –The GP, patient, team, working environment, task, computer system and GP-hospital interface

Preventable medication- related hospital admissions These account for around 1 in 25 hospital admissions Common causes: –Prescribing problems: 31% –Adherence problems: 33% –Medication monitoring problems: 22% 4 classes of drug account for over 50% of these admissions

Other studies UK CQC report 2009 raised major concerns about managing patients medicines after discharge from hospital CHUMS: two-thirds of care home patients are exposed to medication errors Numerous studies have shown that clinical computer systems can reduce medication errors, but they can also increase the risks of some types of error

Strategies for improving safety and improving patient outcomes Current risks to patients are unacceptable and so actions must to taken to improve medication safety and improve patient outcomes A number of strategies relevant to community pharmacies are available

Managing medicines and empowering patients Great opportunities to educate patients, empower patients and improve adherence Need dedicated time, and skills, to undertake these activities effectively

Maximising patient care through access to EHR Most community pharmacists do not have access to the information they need for effective medicines optimisation Access to the EHR would greatly improve this situation The PINCER trial has demonstrated up to 50% reductions in medication errors from a pharmacist-led IT-based intervention

Engaging in collaborative care GPs do not have the time to: –Fully discuss new medicines with patients –Undertake thorough medication reviews for patients on multiple medications Community pharmacists have a potentially major role in improving patient outcomes for patients, but need the skills and opportunities to do this

Ensuring continuity of pharmaceutical care Community pharmacists have a potentially important role in ensuring continuity of pharmaceutical care at transition between acute care and home Need to identify effective methods for communicating information to community pharmacies

Summary European Community Pharmacy Blueprint provides an ambitious and appropriate way forward Community pharmacists have much to offer in improving treatment outcomes Need better access to the EHR, better collaboration with GPs and secondary care, and dedicated time and training in order to realise this great potential