Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

With any new system there is a need to communicate the vision and benefits arising from such a system, to all professionals involved with a specific patient service. To do anything in isolation will not prove successful, and is a waste of valuable resources.
Taking the time to communicate effectively, whether you are in a hospital or a community setting, is the key to ensuring new services actually begin to work.
Ensuring that an efficient liaison exists between the hospital setting and the community pharmacist/GP setting, is seen primarily as a hospital responsibility.
But opportunities must exist for developing a creative two-way communication, and community pharmacists ought to mobilise, to assist in making a contribution to the whole.

In the April edition of i2P E-Magazine, I discussed the new clinical pharmacy referral system (MARS-Rx...Monitoring and Referral System) we are trialing at my workplace.
With any system of this kind the communication required to make it work properly and effectively must be carefully planned.

For the moment, we use the following tools for communication, after each consultation:

* A written report to the referrer, which may detail the patient's medication history, the problems identified with their treatment and the recommendations arising.
We keep a copy of this report to monitor outcomes from our recommendations, as a quality control measure.

* Comments in the patient's notes, to ensure that our recommendations are documented officially, and are seen by prescribers and other professionals.

* A copy of the report, with patient details removed, is published in a regular magazine style publication. This is distributed to leading clinicians within the region, to demonstrate what we are capable of achieving, when we work together.

There are many logical extensions that could be explored in the future.
Improved communication both with GPs and community pharmacists is constantly being touted as the way of the future, but only now are major steps being taken in most areas to achieve this.

What we perceive as being an optimal liaison between community pharmacy and the hospital goes along these lines:

* The patient receives a discharge summary, which lists in brief, all their medications, dosing, brief details on side effects and things to look out for.
They are given some counseling on this and given the chance to ask any questions.

* We ask the patient which community pharmacy they normally go to, and provide a copy of this summary to that pharmacy. This enables community pharmacists to keep in touch with patient details, and give them lead-time to prepare their own comprehensive reinforcement counseling materials.

* A copy of the sheet is sent to the GP, who will write new prescriptions.

* The patient presents their new prescriptions at the community pharmacy, where one of the pharmacists is familiar with their new profile and is able to provide improved counseling.
There may also be a need for Consumer Medication Information (CMIs) and perhaps to assess for concordance (with a view to suitability for Webster-Paks or similar), and the possibility of a Home Medicines Review (formerly Domiciliary Medication Management Review (DMMR)) for those who are in need.
Even though a patient may have been reviewed in the hospital, this cannot equate to the same personal level achieved by community pharmacists, and the focus on the issues related to taking and storing medication in the home environment as well as a DMMR involving a home visit from the community pharmacist.

The current need for patient details to be transmitted by sheets of paper could be avoided through the proposed Better Medication Management System (BMMS).
The transfer of the patient's latest medication profile to a smart-card or central database or other suitable electronic format, would create efficiencies we can't really imagine at the moment.

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