Summative service and stakeholder evaluation of an NHS-funded community Pharmacy Emergency Repeat Medication Supply Service (PERMSS)

Assessment of Pharmacists Prescribing Practices in Poland-A Descriptive Study

Pharmacists play a beneficial role in supplying medicines to patients. Pharmacist prescribing practices were introduced into law in Poland in 2002, permitting pharmacists to prescribe medications in emergency situations and in 2020 the new law allowed to prescribe in all situation where it is needed because of the health risks reasons. Our aim was to analyze pharmacist prescribing practices in Poland and confirm the useful of pharmacists' activity in this area. Additionally, pharmacists were also authorized to issue reimbursed prescriptions for themselves or their family members. Since January 2020, only e-prescriptions are allowed in Poland. A retrospective analysis of the inspection written reports from 842 community pharmacies in the representative region of Poland with a population of two million, carried out in the time period from 2002 to 2016 was performed (2189 prescriptions) to assess the emergency pharmacist prescribing practices in Poland. The second part of the research was based on digital data on pharmacists prescriptions (18,529) provided by the e-Health Centre (a governmental organization under the Ministry of Health responsible for the development of health care information systems in Poland), enabling to conduct the analysis of pharmacist's prescribing from 1 of April 2020 to 31 of October 2020. The analysis gave the insight of the evolution of the pharmacy prescribing patterns. In general, pharmaceutical prescriptions were issued in cities with more than 100,000 inhabitants, in town- or city center pharmacies, and in pharmacies in residential areas. The most common reason for a pharmaceutical prescription was that the patient was running out of a medicine and was unable to contact their physician. Cardiovascular, respiratory, dermatological, and digestive medications were most frequently prescribed. An analysis of pharmacists' prescribing data from 1 April 2020 to 31 October 2020 confirmed the rapid increase of pharmaceutical prescriptions following implementation of the new legislative act during the COVID-19 epidemic.

An investigation into the number and nature of the urgent care consultations managed and referred by community pharmacists in South-East England

BACKGROUND

Community pharmacies are recognised as an under-utilised, accessible resource that could support the urgent care agenda. This study aimed to provide a snapshot of the number and nature of urgent care requests presented to a sample of community pharmacies in three counties in southern England, to determine how requests are managed, whether management is appropriate, as assessed by a group of experts, and whether customers receiving the care are satisfied with pharmacists' interventions.

METHODS

A representative sample of pharmacists across the region was invited to keep a log-book documenting all urgent care requests over a two-week period. Data were analysed to estimate frequency and type of requests and to compare consultations in core and non-core hours. Log-book entries were scrutinised blind by an expert panel to determine appropriateness of pharmacist's responses. Customers receiving pharmacists' interventions were surveyed to assess satisfaction.

RESULTS

Seventeen pharmacies kept log-books detailing 432 urgent care consultations, equating to 13 consultations per pharmacy per week. Of these, 70% (n = 302) were dealt with by the pharmacist in-house with 30% (n = 130) resulting in referrals. Locum pharmacists were significantly more likely to refer to other NHS services than regular pharmacists. Over half the requests were for symptom management, skin problems presenting most commonly (38% of all symptoms presented). Forty-seven percent of consultations were considered to have 'averted the need for other NHS services'. Pharmacists' referral (but not assessment of urgency) was deemed appropriate by the expert panel in 90% of consultations. Ninety-five percent of customers surveyed were satisfied with the service and would use the pharmacy again.

CONCLUSION

Extrapolating findings across the study population (approximately 4.4 million) suggests that community pharmacists manage over 11 500 urgent care consultations per week, with 8050 managed independently. These prevent approximately 5400 other NHS encounters, while also meeting customer expectations and expert panel endorsement.

Remunerated patient care services and injections by pharmacists: An international update

Objectives

Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services.

Data sources

Systematic searches for relevant articles published from January 2013 to February 2018 across PubMed (MEDLINE), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed.

Study selection

Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing.

Data extraction

Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial or regional level, as applicable), payer, service description, patient eligibility criteria and fee structure.

Results

Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service.

Conclusion

Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation. Can Pharm J (Ott) 2019;152:xx-xx.

Remunerated patient care services and injections by pharmacists: An international update

OBJECTIVES

Recognizing pharmacists' increasing roles as primary care providers, programs offering remuneration for patient care services, and the administration of injections by pharmacists continue to be implemented. The objective of this article is to provide an update on remuneration programs available to pharmacists internationally for nondispensing services.

DATA SOURCES

Systematic searches for relevant articles published from January 2013 to February 2018 across Pubmed (Medline), Embase, International Pharmaceutical Abstracts, Cochrane Library, Econlit, Scopus, and Web of Science. Gray literature searches, including targeted searches of websites of payers and pharmacy associations, were also performed.

STUDY SELECTION

Programs were included if they were newly introduced or had changes to patient eligibility criteria and fees since previously published reviews and if they were established programs offered by third-party payers for activities separate from dispensing.

DATA EXTRACTION

Descriptive information on each program was extracted, including the program's jurisdiction (country and state, provincial, or regional level, as applicable), payer, service description, patient eligibility criteria, and fee structure.

RESULTS

Over the 5-year period studied, 95 new programs for noninjection patient care services and 37 programs for pharmacist-administered injections were introduced. Large ranges in fees offered for similar programs were observed across programs, even within the same country or region, at an average of $US 71 for an initial medication review, $19 for follow-ups to these reviews, $18 for prescription adaptations, and $13 for injection administration. Apart from some smoking cessation programs in England, which offered incentive payments for successful quits, all services were remunerated on a fee-for-service basis, often in the form of a flat fee regardless of the time spent providing the service.

CONCLUSION

Although funding for pharmacists' activities continues to show growth, concerns identified in previous reviews persist, including the great variability in remunerated activities, patient eligibility, and fees. These issues may limit opportunities for multijurisdictional program and service outcome evaluation.

New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation

OBJECTIVES

To evaluate an electronic patient referral system from one UK hospital Trust to community pharmacies across the North East of England.

SETTING

Two hospital sites in Newcastle-upon-Tyne and 207 community pharmacies.

PARTICIPANTS

Inpatients who were considered to benefit from on-going support and continuity of care after leaving hospital.

INTERVENTION

Electronic transmission of an information related to patient's medicines to their nominated community pharmacy. Community pharmacists to provide a follow-up consultation tailored to the individual patient needs.

PRIMARY AND SECONDARY OUTCOMES

Number of referrals made to and received by different types of pharmacies; reasons for referrals; accepted/completed and rejected referred rates; reasons for rejections by community pharmacists; time to action referrals; details of the follow-up consultations; readmission rates at 30, 60 and 90 days post referral and number of hospital bed days.

RESULTS

2029 inpatients were referred over a 13-month period (1 July 2014-31 July 2015). Only 31% (n=619) of these patients participated in a follow-up consultation; 47% (n=955) of referrals were rejected by community pharmacies with the most common reason being 'patient was uncontactable' (35%, n=138). Most referrals were accepted/completed within 7 days of receipt and most rejections were made >2 weeks after referral receipt. Most referred patients were over 60 years of age and referred for a Medicines Use Review (MUR) or enrolment for the New Medicines Service (NMS). Those patients who received a community pharmacist follow-up consultation had statistically significant lower rates of readmissions and shorter hospital stays than those patients without a follow-up consultation.

CONCLUSIONS

Hospital pharmacy staff were able to use an information technology (IT) platform to improve the coordination of care for patients transitioning back home from hospital. Community pharmacists were able to contact the majority of patients and results indicate that patients receiving a follow-up consultation may have lower rates of readmission and shorter hospital stays.

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

OBJECTIVES

To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation.

DESIGN

Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation.

SETTING

North East of England NHS 111 provider and accredited community pharmacies across the North East of England.

PARTICIPANTS

Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests.

INTERVENTIONS

NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication.

MAIN OUTCOME MEASURES

Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway.

RESULTS

NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014-7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway.

CONCLUSIONS

NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency.