1. Patient Perceptions of Provision of High–Risk Medicines Education in the Community Pharmacy Setting
Claire Fernie, Patient Representative1; Alec Murray, Associate Improvement Advisor2 and Marie Paterson, Programme Manager1
1 Scottish Patient Safety Programme – Pharmacy in Primary Care, NHS Fife , 2 Healthcare Improvement Scotland
Background
Protocol
In November 2014, the Pharmacy Stream of the Scottish Patient Safety Programme in Primary Care was launched as a pilot within four NHS Health Boards, including NHS Fife.
In the first year, warfarin education was the area of focus, as adverse effects attributed to this high risk medicine are known to account for a number of hospital admissions(1).
This required undertaking new conversations with patients.
A questionnaire was designed, consisting of 15 questions. Ten of these were closed-ended, with the option to offer comments, and the remainder were open-ended.
Each of the 7 participating pharmacies was asked to approach 2-3 patients who would be willing to complete the questionnaire. The majority of the questionnaires were completed over the telephone, in conversation with the patient representative. The remainder were completed face-to-face with the pharmacist.
Fifteen patients participated in completing the questionnaire. 75% of the participants had been taking warfarin for 5 years or more.
Results were transcribed by hand, anonymised and collated and analysed using Microsoft Excel.
Aims
As the work was designed as a pilot study, no inherent provision was made to gather patient feedback.
Within NHS Fife there was a keen interest in eliciting patient comments, in respect of both the receipt of warfarin education from the pharmacist and of patients' views of the role of the pharmacist.
“The poster was on the counter and it provoked me to consider having a small chat about my warfarin.”
Results
Of the two-thirds of participants who recalled speaking to the pharmacist about warfarin:
Happy to discuss warfarin with the pharmacist 100%
Found the information given easily understood 100%
Knew more about warfarin after conversation 60%
Were more likely to ask about other medications in 70%
the future
Of all 15 participants who completed the questionnaire:
Happy the pharmacist is told about hospital 93% admission/discharge
Happy the pharmacist is told about medicine 93%
changes/reasons for stay on hospital discharge
Of those who saw information posters/ leaflets
(not available in every pharmacy)
Posters and/or leaflets were useful %
But...
When all 15 participants were asked when they had last received warfarin education, other than from the pharmacist:
More than 3yrs/some time ago %
No idea/don't remember %
… and 33% of our cohort did not recall the conversation with the pharmacist (which we know occurred)
“The pharmacist reinforced the extensive information I received from my GP. They are generally very helpful and pro-active and good at picking up any errors.”
“I'm pleased that the pharmacist is paying attention to my medicines interactions – it's good to know that someone's checking.”
Conclusions
and future work
Although the cohort number was small and participants were selected based on their willingness to participate, the questionnaire responses indicate that the community pharmacy setting is an accessible, highly acceptable route for patient education and that patients are comfortable with communicating in this way with the pharmacist.
However, recollection of receiving education about warfarin management was poorer than expected. In recent years, warfarin education has been prioritised in Primary Care through the Scottish Patient Safety Programme, and these results suggest that continued reinforcement is required.
“Talking to the pharmacist was a reminder of my current knowledge. I've always been happy to ask the pharmacist about my medications.”
“The pharmacist's role is better now, they have more information and I'm more comfortable talking to them – they don't talk down to you.”
“I'm considering changing to a new anticoagulant in the New Year and will consult/have consulted my pharmacist.”
“Since I've become less well and used the pharmacist more I've found them very friendly and always concerned about how I'm doing. They are very approachable.”
“ I find the pharmacist very good and will use them in lieu of a doctor's appointment.”
Reference: Pirmohamed M. et al., Adverse drug reactions as cause of admission to hospital: prospective analysis of patients
BMJ Jul 3; 329 (7456): doi: /bmj
With thanks to the participating pilot pharmacies, to Sheila Dall from Fife Pharmacy Services and to Natalie Weir and
Emma D. Corcoran from Strathclyde University