Making a difference
Pharmacy technician Pippa Scrimshaw has been talking to patients in their own homes about their medicines for over 12 years and can’t imagine doing anything else.
The problem of patients not taking their medicines as they should do is well established: anything between a third and half of medication prescribed for long-term conditions is thought to fall into this category. While pretty much everyone working in pharmacy is doing all they can to improve adherence rates, few can claim to be tackling the issue on a full-time basis. But this is exactly what Pippa Scrimshaw is employed to do.
Starting from scratch
The role of specialist domiciliary medicines management pharmacy technician was new when Pippa was first appointed over a decade ago. This meant that in the early days, much of her time was spent publicising the service, not just to patients, but also to a wide range of healthcare professionals (HCPs). Uptake was initially slow, but Pippa says that once a GP saw how beneficial her visit was to a patient, more referrals soon followed.
So what does Pippa actually do? On paper it appears simple: a referral is made – perhaps by a person who feels they or someone they know are in need of some support, or by an HCP who has a patient who is struggling with their medication – and Pippa arranges an appointment. On the day, she arrives at their home and asks them to show her the medicines they are taking. She talks with the patient, making suggestions as to how they could improve their adherence, and works with relevant HCPs and carers to implement any next steps, such as putting in place an electronic tablet dispenser, electronic dose reminder alarm, large print labels or a medication review.
Pippa has several resources that assist her. “I have access to the county council’s assistive technology team, which means I can put in place compliance aids if needed. I use the regional medicines information service based at Ipswich Hospital, and I look things up on the Electronic Medicines Compendium and British National Formulary websites. I also have the Trust’s pharmacy team to call on, which is really valuable.”
Gently does it
In practice, the process is more individualised. As Pippa says: “From the moment I walk through someone’s front door, I start to get a feel for what they are like. For example, if the home is cluttered, I know they may well be unable to find their medicines when they need them, let alone take them as they should.”
As well as comparing what the patient is taking with what their medical record states they are being prescribed, Pippa looks at other aspects, such as inhaler technique, and how much they have of each item in order to try to synchronise them. It is perhaps unsurprising that Pippa frequently comes across cases in which a certain medicine is not being taken at all, which she tackles with the same gentle approach that pervades her work.
“It’s not my place to tell someone off for not taking something as prescribed,” she explains. “Sometimes someone might not be taking a medicine because they don’t understand how it can help them – this is very common for blood pressure medication, for example – but in other cases, they may have a good reason for not wanting to take it, such as a side effect that they find difficult to manage. I don’t assume they should be taking everything that’s been prescribed; instead, I think ‘do they need it?’”
The ‘write’ access
Pippa makes only brief notes during her home visits, using a printout of the patient’s medication she is able to pull off SystmOne. Having access to this – the clinical computer system used by many local NHS settings – also facilitates much of Pippa’s communication with HCPs, as she is able to write into patient notes and use messaging and ‘tasking’ functions. Those not on SystmOne (e.g. community pharmacies) she contacts in person, by telephone or letter.
The elderly make up the bulk of Pippa’s patients, but they aren’t the only group to benefit from her expertise. “Sometimes I will see two people in the same home – a couple perhaps, or, increasingly, an elderly parent and one of their adult children who also has a long-term condition. At the moment, I seem to be getting quite a lot of referrals from the mental health team. It’s certainly always busy!”
One of the most significant pieces of work Pippa has undertaken has been to show the value of the service. This was achieved by taking part in a study that showed a reduction in the risk associated with medicines use and the benefits of Pippa’s intervention to both patients and HCPs. It also showed financial savings – crucial in a climate of cuts to public spending.
Pippa concludes: “I used to work in a hospital pharmacy and I don’t know that I could go back to that now. I love the patient contact I get in this job, and I really feel I make a difference because I am able to look at the patient as a whole and not just in terms of their medicines. I’ve also been doing it so long that I have a good sense for what will work for someone and what won’t, and I can usually find an answer to the majority of problems people are having. I enjoy what I do, I really do.”
I love the patient contact I get in this job, and I really feel I make a difference
Put it into practice
Not everywhere has a domiciliary medicines management service to call on, but Pippa says that elements of what she does can be put into place in community pharmacy. Her top tips are:
- Keep a watchful eye on what patients are ordering when they put in a repeat prescription request. If they aren’t asking for something that is on their record, ask why that is
- Often those most in need of help can’t get to the pharmacy, so ask delivery staff to be vigilant when they go into people’s homes for potential problems, such as unopened bags of medicines, and let someone in the dispensary know if anything seems amiss
- It’s easy to go into autopilot when dispensing prescriptions for delivery, but the people receiving the medication require as much care and attention as those who are standing in the pharmacy waiting for their items.
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