Supporting Medicines Adherence

摘要

People with chronic health conditions often need multiple medications taken at different times, and this can lead to the patient having difficulty managing all their medications. A new contract between the Ministry of Health, DHBs and pharmacies in 2012 signalled a shift to more patient-centric services. Proactive medicines management helps to reduce errors, while improving the quality of therapy, coordination of care, creating direct cost savings for the DHB and patient in medication management. This agreement re-allocated funding for the targeted care that pharmacies provide for patients with multiple medications and poor adherence. It better recognises pharmacy staff’s expertise and their contribution in primary care. Pharmacies required tools to support their patient-focused approach. Despite being an integral part of the care team, pharmacists typically had poor visibility of patients’ diagnosis and other relevant assessments and care plans. Participating in a 2015 pilot of a Medication Adherence Support Service (MASS) module on Whānau Tahi’s Connected Care (WTCC) platform enabled Waimauku Village Pharmacy to re-design its model of care and business practices. Multiple pharmacies from the Northern region contributed insights to MASS, which enables a pharmacist to assess a patient’s medications adherence. Based on the assessment, pharmacist and patient agree a Medications Adherence Plan. The pharmacist can also maintain a Managed List of Medications, implement patient specific tasks tailored to assist better medicine management and improve adherence The Medications Adherence Plan and Managed List of Medications are part of a patient’s Shared Care Plan and can be seen and updated by other care team members and authorised clinicians including those in emergency departments. The module overcomes many common barriers to adoption by including “launch in context” integration from Pharmacy Management Systems LOTS and Toniq. Delivered ‘as a service’, the solution can be accessed with no additional IT support within a pharmacy. In the Northern Region, it is part of the regional “e-Shared Care” solution so all users of e-Shared Care and other regional systems (e.g. Concerto) can access the Plan and List without any additional integration. Various DHBs nationwide are now exploring how to use WTCC MASS to support LTC-eligible patients. MASS is aiding the transition of pharmacy services from patient-initiated medicine supply to more proactive, patient-centred pharmacy care. More efficient business practices frees up staff to spend more time with patients and really understand their needs which in turn reduces the burden of care for higher-needs patients. It also enables pharmacists to maximise the value of the LTC component of the Community Pharmacy Services Agreement. At Waimauku Village Pharmacy, for example, pharmacist Robbie Hanon redesigned his whole pharmacy model of care for LTC patients, based on WTCC, resulting in a 50% increase in patients seen with no additional staff costs. Future gains may also be made through improved Information capture at each patient encounter and reporting to reduce the audit burden on pharmacies. Communication with fellow healthcare professionals and providers is supported, with pharmacies using recognisable clinical presentations, display of information and the fit with the wider patient -centric care planning.