Role of Clinical PharmacistFacilitators in Hawke’s Bay

Billy Allan – Chief PharmacistAnne Denton – Team LeaderBrendan Duck – CFP Totara HealthVanessa Brown – CFP Greendale Family Health/Taradale MedicalJenni Jones – CFP Hastings Health CentrePeter McIntosh – CFP Te Mata Peak PracticeDi Vicary – Population-based Pharmacist, Health Hawke’s Bay

Background

A collaboration between

DHB Hawke’s Bay

PHO Health Hawke’s Bay

GP practices

Why clinical pharmacist facilitation?

$200,000 year-on-year increase in combined pharmaceutical budget CPB = community pharmaceuticals

+ pharmaceutical cancer treatments

+ vaccines (from 1 July 2013)

Not sustainable

No ‘low hanging fruit’

Hawkes Bay pharmaceutical expenditure (12 month rolling totals)

Data source: Pharmac Drug expenditure report for DHB for year ending Sep-10

$1,500,000

$6,500,000

$11,500,000

$16,500,000

$21,500,000

$26,500,000

$31,500,000

$36,500,000

Feb-0

4A

pr-

04

Jun-0

4A

ug-0

4O

ct-

04

Dec-0

4F

eb-0

5A

pr-

05

Jun-0

5A

ug-0

5O

ct-

05

Dec-0

5F

eb-0

6A

pr-

06

Jun-0

6A

ug-0

6O

ct-

06

Dec-0

6F

eb-0

7A

pr-

07

Jun-0

7A

ug-0

7O

ct-

07

Dec-0

7F

eb-0

8A

pr-

08

Jun-0

8A

ug-0

8O

ct-

08

Dec-0

8F

eb-0

9A

pr-

09

Jun-0

9A

ug-0

9O

ct-

09

Dec-0

9F

eb-1

0A

pr-

10

Jun-1

0A

ug-1

0

12 months to

Aging PopulationItems Dispensed per Capita by Age

Comparison of dispensing rates by age group (items),

January to December 2010

0.0

20000.0

40000.0

60000.0

80000.0

100000.0

120000.0

0-14

years

15-24

years

25-44

years

45-64

years

65-84

years

85+ years Total (all

ages)

Rate

(cru

de)

per

1000 p

opula

tion

Haw ke's Bay New Zealand

Source: Pharmaceutical Claims Data Mart, Ministry of Health (Extracted: 22/4/2011). Note data subject to

change over time.

Aims

Interventions targeted at polypharmacy

≥ 65 years

Would not disadvantage Māori, Pacific or

NZDep 9/10

Polypharmacy

patient harm / ADRs

Fulton & Allen 2005

The model

Clinical pharmacist facilitators (3.5 FTE)

Focus on best practice – not cost

To complement the population based clinical pharmacist facilitator (1.0 FTE)

Medicines and Diagnostics

Funded by DHB working out of PHO

in specific practices

The Practices (at present)

Totara Health, Hastings and Flaxmere. Targeted population: patients with high needs including Māori and Pacific and NZ Dep 9/10.

Te Mata Peak Practice, Havelock North. Targeted population: High enrollment of patients living in ARRC.

The Practices (at present)

Greendale Family Health, Greenmeadows. Targeted population: high percentage of patients 65 years or older living in own home.

Taradale Medical Centre, Taradale. Targeted population: high percentage or enrollments aged 65 years or older.

The Practices (at present)

Hastings Health Centre, Hastings. Targeted population: over 65 years and high needs patients.

What do they actually do? (1)

Medicines Reviews

Medicines Therapy Assessments (MTA) With on going monitoring of

changes

Medicine reconciliation Discharge to home

Admission to ARRC

Targeted T2DM CVD risk reduction BP

LDL

HbA1c

Education Patients – including

adherence support

GPs

Practice nurses

ARRC staff

Adherence screening tool T2DM Undertaken at routine

Diabetes review by RN

What do they actually do? (2)

Medicine information queries

Falls reduction (vitamin D in ARRC)

MRFRAT

Bulletins digoxin, blood glucose

dabigatran

Cornerstone accreditation preparation Review of medicine policies

and standing orders

DUEs

Citalopram (QT)

Dabigatran (ClCr)

Oral methotrexate (monitoring and day of week)

The Triple Aim

The Population• Lowering of HbA1c• Lowering of blood pressure• Lowering of lipids• Greater adherence to medicines• Nurse run diabetes clinics with CP

advice available

The Individual• More appropriate medicine regimes• Less polypharmacy• Fewer falls• Fewer hospital admissions• Fewer ED presentations• Safer transition between services• Greater patient satisfaction

The System• Reduced cost of drugs • Fewer events / hospitalisations• Fewer rest home admissions • Fewer ADRs

Where to from here?

Plan is to have the equivalent of 8 FTE CPFs

Four new Clinical Pharmacists have been employed

Starting date 14.12.2015

Will be in GP practices January 2016

The team … so far…