A study of patient pharmaceutical care needs assessment in chronic obstructive pulmonary disease; as an example of a multidisciplinary intervention to reduce hospital re-admission in long term conditions

Abstract

Introduction — The aim of Edinburgh Improved Anticipatory Care and Treatment (IMPACT) service is to reduce admissions and re-admissions to hospital for people with LTCs. The service consists of nurse case managers co-ordinating patients’ care, including reviewing medication. As a pilot project, an arrangement was made to refer such patients to a team of primary care pharmacists for clinical medication review. This project will examine the pharmaceutical care needs of this particular patient group and prepare an electronic system for reporting pharmaceutical care contributions in the evaluation of this service.

Methods — A model of care for COPD was generated to characterise the pharmaceutical care needs of patients recruited into the anticipatory care service from a pharmacy perspective. A generic database was designed for the purposes of characterising patients and for addressing their pharmaceutical care needs. Anonymous and categorised pharmaceutical care plans from the pharmacists conducting the medical reviews was used to populate the database. A pharmaceutical care plan for COPD was proposed to match the database. A qualitative research approach was used in order to design the potential clinical tools in response to specific feedback obtained from a nominal group. The nominal group consisted of pharmacists, three from the primary care pharmacists and one specialist pharmacist.

Results — There were 21 patients’ pharmaceutical care plans included for analysis of care provided to 13 females (62%) and 8; males (38%). The mean age was 74 years (SD 10, range 51-88). COPD are present in 57% of the records (n=12), ischaemic heart failure in 43% (n=9), chronic heart failure in 33% (n=7), chronic kidney disease 33% (n=7), depression in 29% (n=6), myocardial infarction in 29% (n=6), hypertension in 29% (n=6), and diabetes type 2 in 24% (n=5). There were 127 pharmaceutical care issues identified, an mean of 6 care issues per person. Checks accounted for 46 (36%), and there were 65 (51%) changes in drug therapy, and 16 (13%) changes in drug therapy process. The most common drug therapy problem was inappropriate compliance in 35% (n=23) out of all drug therapy problems identified (n=65). The database was face validated by the nominal group and is fit for purpose.

Discussion — The population of the database toolkit was done to demonstrate the functionality of reporting important outcomes from the pilot. For further work it is possible to link disease, medications, and pharmaceutical care issues, which will produce reports indicating the kind of medications or diseases / co-morbidities that are generating most problems. The database is fit for purpose and can be used for further evaluating the medication reviews conducted by pharmacists. It can also be a teaching tool for use during pharmacy education.