Pharmacist

Document Sample
Pharmacist Powered By Docstoc
					Delivery System Redesign Chilliwack Clinic
• The Team
– Receptionist/MOA – RN – Dietician – Pharmacist

• MD discussion with patient about CDM • Appointments arranged monthly • Clinics twice per month

Patient flow through office
Patient registers at front desk & fills out questionnaire MOA ushers patient to exam room and introduces patient to RN, dietician, or pharmacist RN spends ¾ hr with patient while MD sees other patients

MD speaks with RN about patient visit and reviews chart of next patient with RN

Patient is ushered to an alternate exam room and fills out 5 min. questionnaire

Patient returns to front desk to book follow-up appointment

MD sees patient for last 10 min. of 1 hr appt.

Readiness to Learn
• How involved do you think you should be?
– Actively – Totally – Very Much – 100% – I should be really involved with CHF – As much as possible – My life depends on it – (3) Don’t know

Registered Nurse
• PREPARATION
– – – – Written teaching guide Prepared Patient Questionnaire – Visit with RN Written PDSA cycle Resources obtained

• RESOURCES USED
– Heart &Stroke Foundation: Managing CHF booklet – CHF guideline: Patient Reminders/Resources sheet – Canadian CHF Clinic Network: Patient Info sheet

Registered Nurse
• SELF MANAGEMENT VISIT
– – – – – – – – – (individualized, unique, varied, complex) Reviewed ‘Readiness to Learn’ Q&A ? Their experience with CHF ? Their interest in discussing CHF ? Their ability to recognize S&S of CHF Talked about A&P and Symptom management concept Opportunity to address questions/concerns Offered resources and follow-up options Patient questionnaire

Registered Nurse
• CLIENT FOLLOW-UP
– Physician: immediately after RN visit – Dietician – Pharmacist

• PDSA CYCLE
– Nurse educator self assessment – Review responses to Patient Questionnaire

Dietitian
• PREPARATION:
– individual appointments: time and process

• RESOURCES USED:
– Nutrition Data Form – Sodium and Fluid Restriction Handouts – Other Nutrition Handouts

Dietician
• WHAT TO EXPECT:
– co-morbidity and dietary complications – family support – keen interest to improve diet – restaurant eating issues – grocery buying and label reading

Dietitian
• FOLLOW-UP
– Individual – Mail outs – Grocery Store Tour

Pharmacist
• PREPARATION
– Letter to community pharmacists – Initial/follow-up assessment forms – Medications calendar – Pharmanet/chart review

• RESOURCES
– Heart & Stroke Foundation (patient) – CHF literature/practice guidelines

Pharmacist
• WHAT TO EXPECT
– Patient education (CHF/medications) – Co-morbid conditions/medications – Goals/monitoring/outcome of therapy – Compliance – Side effect management – Herbal/OTC therapy

Pharmacist
• FOLLOW-UP
– Phone call follow-up • medication additions/changes • adverse effects/side effect management • questions/concerns – Contact information provided – Follow-up assessment form sent to clinic

Assessment
• Patient assessment • RN, dietician and pharmacist assessment • MD assessment

Patient Assessment RN visit
RN Visit
Improved understanding of CHF Session helpful

Per Cent 84% 91%

More confident in Self Management
Would recommend RN visit for others Would like to see dietician Would like to see pharmacist Aware of community & ed resources

80%
94% 66% 64% 69%

Patient Assessment Dietician
Dietician Visit
Understanding how diet effects CHF
More confident in right food choices

Per Cent

95%
94% 99% 100% 95% 58%

Session helpful Would recommend dietician visit for others Other dietary concerns addressed Group visit would be just as useful

Patient Assessment Pharmacist
Pharmacist Visit
Improved understanding of CHF meds

Per Cent
93%

Group visit would be just as useful
Discusses meds with retail pharmacist

39%
18%

Interested in group follow-up session
Would recommend pharmacist visit for others Also taking herbal medications Some problems with remembering pills

61%
92% 30% 20%

Team Member Assessment
• • • • • • • Enjoyed the change from daily routine Scheduling by Receptionist a bonus Direct communication with the Family MD Felt appreciated by the patients Would do it again Would recommend it to other colleagues But RNs, dieticians & pharmacists are in short supply

MD Assessment
• • • • Enjoyed working as a team High quality team members Able to provide a needed service Works better with my schedule if there are extra exam rooms • Appreciated by the patients • Results in better health outcomes • Would recommend it for other MDs to try

Results
• Reduced hospital admissions (N=35)
– First 4 months – Second 4 months – 2/3 year 36% reduction 57% reduction 46% reduction

Sustainability and Spread
• Cost analysis – saved hospital admissions • Will depend on quality team members being available • Only one of many models of delivery system redesign – one model will not fit all


				
DOCUMENT INFO