Impacts on practice
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Intermediate care is an evolving healthcare setting that provides an alternative to hospital for older adults, yet community pharmacists have little awareness of, or involvement with such services.
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Community pharmacists could have a role to play in providing medicines management services to patients in intermediate care, which may improve the currently suboptimal communication of information relating to patients’ medications between hospital, intermediate care, and primary care settings.
Introduction
Aim of the study
Ethics approval
Methods
Results
Response rate and demographics
Study respondents n (%) | PSNI n (%) | ||
---|---|---|---|
Gender | |||
Male | 79 (41.6) | 666 (33.3) | |
Female | 111 (58.4) | 1337 (66.7) | |
Age (years) | Age | ||
<25 | 11 (5.8) | ≤25 | 144 (7.2) |
25–34 | 71 (37.4) | 26–35 | 873 (43.6) |
35–44 | 55 (28.9) | 36–45 | 525 (26.2) |
45–54 | 42 (22.1) | 46–55 | 326 (16.3) |
55–64 | 11 (5.8) | 56–65 | 119 (5.9) |
≥65 | 0 (0.0) | 66–70 | 4 (0.2) |
≥71 | 12 (0.6) | ||
Years practising | |||
≤5 | 42 (22.1) |
a
| |
6–11 | 45 (23.7) | ||
12–17 | 35 (18.4) | ||
18–23 | 23 (12.1) | ||
24–29 | 26 (13.7) | ||
30–35 | 14 (7.4) | ||
≥36 | 2 (1.1) | ||
Missing | 3 (1.6) | ||
Type of community pharmacy | |||
Independent | 106 (55.8) |
a
| |
Multiple | 84 (44.2) | ||
Location of community pharmacy |
a
| ||
Urban | 84 (44.2) | ||
Suburban | 43 (22.6) | ||
Rural | 62 (32.6) | ||
Missing | 1 (0.5) | ||
Average number of prescription items dispensed on a weekday | |||
<50 | 4 (2.1) |
a
| |
50–199 | 57 (30.0) | ||
200–400 | 84 (44.2) | ||
>400 | 38 (20.0) | ||
Missing | 7 (3.7) | ||
Age profile of patients using pharmacy | |||
Majority <65 years | 42 (22.1) |
a
| |
Majority ≥65 years | 142 (74.7) | ||
Missing | 6 (3.2) | ||
Additional prescribing qualifications | |||
None | 173 (91.1) | 1790 (89.4) | |
Supplementary prescriber | 7 (3.7) | 14 (0.7) | |
Independent prescriber | 10 (5.3) | 199 (9.9) | |
Currently using prescribing qualification (of those qualified) | |||
Yes | 8 (29.6) |
a
| |
No | 19 (70.4) |
Awareness of and involvement with intermediate care
Statement | SA n (%) | A n (%) | NAD n (%) | D n (%) | SD n (%) | M n (%) |
---|---|---|---|---|---|---|
I understand what is meant by the term ‘intermediate care’ | 11 (5.8) | 79 (41.6) | 34 (17.9) | 53 (27.9) | 12 (6.3) | 1 (0.5) |
I am aware of the intermediate care facilities in my local area | 9 (4.7) | 61 (32.1) | 28 (14.7) | 78 (41.1) | 12 (6.3) | 2 (1.1) |
I think community pharmacists should have greater involvement with intermediate care facilities/services | 64 (33.7) | 88 (46.3) | 29 (15.3) | 8 (4.2) | 0 (0.0) | 1 (0.5) |
I would like to have greater involvement with intermediate care facilities/services | 63 (33.2) | 92 (48.4) | 26 (13.7) | 8 (4.2) | 0 (0.0) | 1 (0.5) |
Communication across the healthcare interface
Statement | SA n (%) | A n (%) | NAD n (%) | D n (%) | SD n (%) | DK n (%) | M n (%) | Score (median; IQR) | Wilcoxon signed-ranks test (two tailed) |
---|---|---|---|---|---|---|---|---|---|
Communication is good between my pharmacy and | |||||||||
GPs | 17 (8.9) | 89 (46.8) | 31 (16.3) | 36 (18.9) | 17 (8.9) | – | – | – | – |
IC | 1 (0.5) | 25 (13.2) | 53 (27.9) | 48 (25.3) | 24 (12.6) | 39 (20.5) | – | 3.0; 3.0–4.0 | Z = −6.67, p < 0.01 |
Hospital | 6 (3.2) | 87 (45.8) | 48 (25.3) | 35 (18.4) | 13 (6.8) | 1 (0.5) | – | 2.5; 2.0–3.0 | |
Sufficient information is communicated to CP at discharge from | |||||||||
Hospital | 18 (9.5) | 88 (46.3) | 24 (12.6) | 35 (18.4) | 24 (12.6) | – | 1 (0.5) | 2.0; 2.0–4.0 | Z = −7.02, p < 0.001 |
IC | 1 (0.5) | 25 (13.2) | 48 (25.3) | 42 (22.1) | 28 (14.7) | 45 (23.7) | 1 (0.5) | 3.0; 3.0–4.0 | |
I often have to contact GP to obtain medication information on patients’ medication after discharge from | |||||||||
Hospital | 78 (41.1) | 71 (37.4) | 19 (10.0) | 19 (10.0) | 2 (1.1) | – | 1 (0.5) | 2.0; 1.0–2.0 | Z = −1.57, p = 0.116 |
IC | 63 (33.2) | 58 (30.5) | 24 (12.6) | 4 (2.1) | 1 (0.5) | 38 (20.0) | 2 (1.1) | 2.0; 1.0–2.0 | |
Information contained in discharge summaries is clearly presented from | |||||||||
Hospital | 19 (10.0) | 109 (57.4) | 32 (16.8) | 22 (11.6) | 2 (1.1) | 4 (2.1) | 2 (1.1) | 2.0; 2.0–3.0 | Z = 6.29, p < 0.01 |
IC | – | 35 (18.4) | 63 (33.2) | 21 (11.1) | 6 (3.2) | 63 (33.2) | 2 (1.1) | 3.0; 2.0–3.0 | |
Information relating to patients’ medications following discharge is communicated to me in a timely manner | |||||||||
Hospital | 4 (2.1) | 81 (42.6) | 46 (24.2) | 41 (21.6) | 15 (7.9) | 2 (1.1) | 1 (0.5) | 3.0; 2.0–4.0 | Z = −4.96, p < 0.001 |
IC | 1 (0.5) | 22 (11.6) | 63 (33.2) | 35 (18.4) | 15 (7.9) | 52 (27.4) | 2 (1.1) | 3.0; 3.0–4.0 | |
I would like to receive more information on patients’ medications at discharge from | |||||||||
Hospital | 86 (45.3) | 58 (30.5) | 21 (11.1) | 22 (11.6) | 2 (1.1) | – | 1 (0.5) | 2.0; 1.0–2.0 | Z = −4.52, p < 0.001 |
IC | 97 (51.1) | 55 (28.9) | 18 (9.5) | 2 (1.1) | – | 17 (8.9) | 1 (0.5) | 1.0; 1.0–2.0 | |
It’s important for me to know a patient’s diagnosis/reason for admission to | |||||||||
Hospital | 45 (23.7) | 95 (50.0) | 37 (19.5) | 11 (5.8) | – | – | 2 (1.1) | 2.0; 1.0–3.0 | Z = −2.53, p < 0.05 |
IC | 44 (23.2) | 81 (42.6) | 45 (23.7) | 9 (4.7) | – | 10 (5.3) | 1 (0.5) | 2.0; 2.0–3.0 | |
It’s important for me to know the reason(s) for changes made to patients’ medication in | |||||||||
Hospital | 72 (37.9) | 91 (47.9) | 19 (10.0) | 5 (2.6) | 1 (0.5) | – | 2 (1.1) | 2.0; 1.0–2.0 | Z = −2.24, p < 0.05 |
IC | 69 (36.3) | 85 (44.7) | 20 (10.5) | 5 (2.6) | 1 (0.5) | 9 (4.7) | 1 (0.5) | 2.0; 1.0–2.0 | |
I think CPs should have access to patients’ medical records in community pharmacies | |||||||||
100 (52.6) | 58 (30.5) | 19 (10.0) | 8 (4.2) | 3 (1.6) | 1 (0.5) | 1 (0.5) | – | – | |
I think patients should be registered with one community pharmacy to ensure continuity of care at healthcare interfaces | |||||||||
77 (40.5) | 60 (31.6) | 31 (16.3) | 15 (7.9) | 3 (1.6) | 3 (1.6) | 1 (0.5) | – | – |
Community pharmacy: intermediate care service implementation
Task | Self-efficacy mean score (±SD) |
---|---|
Counseling IC patients on their medicines | 8.68 (±1.59) |
Providing education to IC staff | 8.40 (±1.78) |
Reconciling IC patients’ medicines | 8.55 (±1.65) |
Providing prescribing advice/make recommendations to prescribers on appropriateness of IC patients’ medicines | 7.65 (±2.28) |
Community pharmacy is ideally placed to deal with issues in intermediate care and should have an important role to play. (R55)
[CPs] are extremely competent in providing advice rather than just dispensing. We have a fountain of knowledge yet rarely get to use it. (R73)
[CPs] are ideally placed to follow up on discharge medication reviews and prevent readmission due to medication errors. (R170)