Medicines management is the pharmacist's role in the future? Richard Cattell Director, South West Medicines Information and Training

Medicines Management and Pharmacists The people The evidence The organisations imperative Being a Consultant

Medicines Management : the definition There is no universal definition Synonym or umbrella term? Definition of medicines management Appropriateness of prescribing, Monitoring of effect Assurance of quality (supply) Assurance of process (administration) (in all areas of patient care)

Medicines Management and Pharmacists The people The evidence The organisations imperative Being a Consultant

The people The Pharmacist Most thorough grounding in Pharmacology / therapeutics Formulation and dosage form design Pharmacokinetics/dynamics Competency driven roles Pre-registration Performance Standards Knowledge and Skills Framework Supplementary Prescribing ‘London’ Competency Framework

Medicines Management and Pharmacists The people The evidence The organisations imperative Being a Consultant

The evidence for the value of a pharmacist Pharmacists attending a post-take ward round 3 year study including 24,000 patients 1.84 contributions to care per patient 50% related to therapeutic choice Supply and patient education Pharm J 2003; 271: (Bednall et al)

The evidence for the value of a pharmacist Pharmacists working in Pre-Admission Clinics 398 consultations in Oxford Transplant Centre 456 clinically significant contributions to patient care (1.14 per pt) IJPP 2004; 12: R27 Prouse & Scott

The evidence for the value of a pharmacist Primary care clinics for patients with hypertension After 5 months…… Pharm World & Sci 2005; 27 (3): Pre-ClinicPost-Clinic Achieved BP 40%80% Aspirin13%80% Statin11%92%

The evidence for the value of a pharmacist Pharmacists working general practices reviewing patient medicines 1188 patients Clinical pharmacist review leads to smaller rises in number of prescribed drugs, cost of prescribed drugs No evidence of increased use of health service BMJ 2001; 323: 1-5 Zermansky et al

The evidence for the value of a pharmacist As clinical pharmacist staffing levels increased from the tenth percentile (0.34/100 occupied beds) to the ninetieth percentile (3.23/100 occupied beds), hospital deaths declined from 113/1000 to 64/1000 admissions (43% decline). Pharmacotherapy 21(2): , 2001 CABond et al

The evidence for the value of a pharmacist Three hospital pharmacy variables were associated with reduced length of stay in 1024 hospitals: drug protocol management pharmacist participation on medical rounds number of clinical pharmacists/occupied bed Pharmacotherapy 21(2): , 2001 CABond et al

Medicines Management and Pharmacists The people The evidence The organisations imperative Being a Consultant

The Organisations Imperative National Service Frameworks Diabetes Diagnosis and management of diabetics in community pharmacies Long term and Elderly Care Medicines Review for all patients on 3 or 4 or more medicines carried out by competent practitioner (pharmacist)

The Organisations Imperative Choosing Health through Pharmacy Pharmacist led Diabetes clinics Cardiac Rehabilitation Improving Medication Safety Audit Commission ‘Spoonful of Sugar’

Medicines Management and Pharmacists The people The evidence The organisations imperative Being a Consultant

Being a Consultant Pharmacist The post Developing the posts The person The competency framework Agenda for Change Transitional arrangements

Being a Consultant Pharmacist An experienced well trained and competent practitioner Champion for medicines management throughout the specialty and organisation Role model for junior pharmacists

Being a Consultant Pharmacist Challenge to current practice Competency demonstrated

So…Medicines Management & the Pharmacists future Pharmacists are best placed to oversee medicines management Evidence abounds as to the benefit brought such an approach The NHS requires of its pharmacists more involvement in medicines management The consultant pharmacist role provide a focus for medicines management activity