Download Lyn Billington Consultant Pharmacist Medication Reviews Australia

Lyn Billington
Consultant Pharmacist
Medication Reviews Australia
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Each year more than 140,000 Australians
have to go to hospital with problems caused
by their medicine. It has been shown that in
up to 69% of these cases the problem can be
avoided. Older people are particularly at risk.
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As a response to this problem, and in light of
research done through the Third Community
Pharmacy Agreement, the Home Medicines
Review (HMR) was developed. It is funded by
the Australian Government and managed by
the Pharmacy Guild of Australia.
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The Sixth Community Pharmacy Agreement
(6CPA) between the Australian Government
and the Guild provides $18.9 billion to
around 5000 community pharmacies for
dispensing PBS medicines, providing
pharmacy programs and services and for the
Community Service Obligation arrangements
with pharmaceutical wholesalers has just
been signed.
No detail yet about funding for programs
such at HMRs.
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Achieve safe, effective and appropriate use of
medicines by detecting and addressing
medicine-related problems that interfere with
desired patient outcomes.
Improve the patient’s quality of life and
health outcomes using best practice
approach, that involves cooperation between
the general practitioner, pharmacist, other
health professionals and the patient ( and/or
carer).
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Improve the patient’s knowledge and
understanding about medications.
Provide medication information to the patient
and other health care providers involved in
the patient’s care.
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GP referral – either through the patient’s
community pharmacy or by direct referral to
an accredited pharmacist. Must have patient
consent.
Accredited pharmacist contacts patient and
makes an appointment ( about 1 hour) to visit
in the patient’s own home.
Appointment occurs.
Patient signs that pharmacist has attended in
their home and is aware a report will be sent
to the GP.
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Accredited pharmacist writes a report and sends
to the GP and the patient’s community pharmacy.
GP follow up with patient at next appointment.
GP feedback to accredited pharmacist (does not
often happen)
Accredited pharmacist contacts GP to discuss
(does not often happen)
Pharmacist /community pharmacy claim for
payment
GP claim for payment – report used in
preparation of a Management Plan for the
patient.
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On five or more medicines;
Taking more that 12 doses of
medications/day;
Significant changes to medication regime in
last 12 months;
Medication with a narrow therapeutic index or
medications requiring therapeutic
monitoring;
Symptoms suggestive of an adverse drug
reaction;
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Sub-optimal response to treatment with
medicines;
Suggested non-compliance or inability to
manage medication related therapeutic
devices;
Patients having difficulty managing their own
medicines because of literacy or language
difficulties, dexterity problems or impaired
sight, confusion/dementia or other cognitive
difficulties;
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Patients attending a number of doctors, both
general practitioners and specialists and
Recent discharge from a facility/hospital in
the last four weeks.
Usually only one HMR in a 24 month period.
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The Australian Association of Consultant
Pharmacy (AACP) developed a national
approach to the “practice” of consultant
pharmacy.
AACP establishes practice standards.
Establishes accreditation procedures and
provides accountable processes for
assessment.
Accredited pharmacists must reaccredit
annually to demonstrate that they have
maintained currency.
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Complete AACP stage 1 course
Complete a portfolio of experience
Pass MCQ exam ( 75%) every three years
Annual CPD submitted – double AHPRA
requirements.
OR
Certification as a Geriatric Pharmacy
Specialist by the Commission for Certification
in Geriatric Pharmacy. ( Through SHPA)
Some examples
Excerpts from some
reports
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Hot Flushes: Mrs Black reported being distressed
by hot flushes which have been occurring for the
last 12 months approximately.
This appears to coincide with the introduction of
tramadol for pain management.
The combination of sertraline and tramadol
would increase the serotonergic load. This would
have the potential to be responsible for hot
flushes.
It would be worth considering trialling the
substitution of Panadol Osteo® as a regular dose
(2 tds) instead of tramadol to see if this would
have the effect of stopping /reducing the hot
flushes.
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Fish Oil and Promensal can cause decreased
platelet aggregation. Taking more than 3 grams
per day of fish oil may keep blood from clotting
and can increase the chance of bleeding.
There have been some reports of
thrombocytopenia with large doses of fish oil.
Mrs Smith had been taking 6G daily until
recently.
She reduced this dose over the last 2 weeks to
2G daily which may explain the latest FBE as
normalising as reported by Mrs Smith
As Mrs Smith felt that the fish oil had provided
no benefit she would cease this medication.
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Bimatoprost eye drops were on the referral
and on the patient drug sheet dated January
2012 and dispensed on 30 July, 2013.
Carer reported patient had had a “sticky eye”
From information from the carer there does
not seem to be a diagnosis of glaucoma.
These drops are not currently being used and
could not be located.
There has been only one bottle dispensed in
the 7 months of dispensing history provided.
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Vivid dreams: Mrs Brown was concerned
about the vivid dreams she experiences.
Propranolol could potentially contribute to
this.
Consideration could be given to a beta
blocker which is less lipid soluble and less
likely to enter the brain – for example
atenolol, and may result in a reduction of
sleep disturbance and vivid dreams.
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Reflux is controlled with esomeprazole.
Noted Mrs Green supplements with vitamin
B12 and has constipation – both could be
contributed to by esomeprazole. A trial of
ceasing esomeprazole could be considered.
Would need to use an antacid mixture for 5-7
days to counteract rebound effect.
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Mrs Black requested to demonstrate how she
used Spiriva – incorrect use resulted in no
medication being administered.
Had told the doctor she was “having trouble
with her bowels”. Prescribed Movicol. Buying
Gastro- stop from the pharmacy.
Insulin stored in a toiletries bag for weekends
away. – Not refrigerated.
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Arrived to visit patient who was extremely
sedated, having frequent falls and severe
diarrhoea.
Had been transferred between two hospitals
following major surgery.
Oxycodone had been ceased. High dose
Coloxyl and Senna had not been ceased – still
packed in Webster.
High dose diazepam prescribed for anxiety
following surgery – continued post discharge.
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Improved medication management.
Increased knowledge for patients on their
medications.
Better health outcomes for patients.
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Mobile 0408184836
Email:
[email protected]