Pharmacy AMS case study
The community pharmacy anti-coagulation management services demonstration, established by Health Workforce New Zealand and the Pharmaceutical Society of New Zealand, sees pharmacists use standing orders to dispense warfarin to selected patients as well as having the authority to modify a prescription in collaboration with GP colleagues.
Traditionally anti-coagulation management in New Zealand has been based in general practices, often delegated to a practice nurse under the supervision of the GP. Managing wafarin in pharmacy settings should mean fewer general practice visits, offering more convenience for patients and freeing up valuable GP and practice nurse time.
Sam Martin is a pharmacist at one of 15 demonstration sites nationwide that are taking part in the extended practice project.
Sam, pharmacist at Huntly West Pharmacy, chose community pharmacy because he likes being part of the community and working with local people. ‘I like interacting with people and being there “at the top of the cliff” rather than at the bottom.’
Sam says the pharmacy has been getting some very positive feedback since the demonstration began in late 2010. ‘Patients are finding it easier to come to the pharmacy and like that they can come any time of the day. They can discuss what’s going on for them and this helps us to help them manage their condition better. We’re finding they’re becoming more involved in their own care.’
In the beginning, Sam says, patients were a bit hesitant to discuss matters but after a few tests they opened up more and have been happy to take part in the trial. ‘Some have become more like a friend and building that relationship helps to get ideas about their treatment over to them. It’s easier to educate a patient when they feel comfortable discussing things in their day-to-day lives that might affect their medication.’
Sam says that the pharmacist is more likely to have the time to sit down and have a longer talk about the patient’s condition than their doctor or practice nurse. The majority of patients are seen every two to three weeks so a good relationship is established quite quickly and some will call in between times if they’ve got a question.
‘Our local GPs seem to be pretty happy with the result and the practice nurses have found that they’ve had their time freed up to do other things. It’s a truly collaborative effort with the GP and results are reviewed straight away. Previously some patients would have to phone their doctor to get their dose and with either no home phone or no credit on their mobile it was making the process difficult.’
Sam says that it was important to take time to gain the trust of GPs but progress has been good. He also recognises the importance of the project in changing the public perception of what community pharmacists do and in showing there’s a lot of room for growth in the services community pharmacies can provide. ‘In the past we’ve been seen as retailers and dispensers but we can teach about warfarin and review medication to ensure patients are receiving the correct dose and I think that’s positive. I find working in the community rewarding, I’m well supported and mentored, I’ve learned how to deal with people and offer a valuable service.’
Now the services at Sam’s pharmacy are being extended and he sees the potential for further expansion. ‘I’m consulted a lot more on other things now that people are coming to terms with what a pharmacist can do and are becoming familiar with our area of expertise. It opens doors and gets you thinking in a different way. I’m looking forward to seeing how projects like this can be applied to other situations.’