Was there any follow up in the community of these patients after maybe six months to see which medications got restarted?

Lucy Little, Lead Clinical Pharmacist (Annandale & Eskdale), NHS Dumfries and Galloway:
Six month follow up is scheduled for these patients. This has not yet occurred. Reviewing patient outcomes in as much detail would not be sustainable long term.

Did the Clinical Frailty Score get coded in the GP clinical systems?

Lucy Little, Lead Clinical Pharmacist (Annandale & Eskdale), NHS Dumfries and Galloway:

There are currently discussions on where best to record the Rockwood Score. There has been some agreement locally that a frailty tab on the clinical portal would be most accessible for all care providers and across sectors and disciplines.

Where a frailty score was present this was read coded in the consultation.

How was the polypharmacy review service funded?

Lucy Little, Lead Clinical Pharmacist (Annandale & Eskdale), NHS Dumfries and Galloway:

The work follows on from the HIS work on polypharmacy reviews. Ensuring safe and effective use of medication underpins a lot of our purpose in general practice. This work was built into daily workload where all roles within the general practice pharmacy team were involved.

Would be interested to know if you had any data regarding if the service prevented acute hospital admissions due to your intervention?

Lucy Little, Lead Clinical Pharmacist (Annandale & Eskdale), NHS Dumfries and Galloway:

No tangible detail if patient outcomes improved or impact on admissions.

Did you start any medications? For example, PPI protection or bone protection?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

Yes, as part of the 7 steps to appropriate polypharmacy process, if we found something was missing it was added. For example, we added calcium with vitamin D to cover a patient taking long term steroids for polymyalgia rheumatica (PMR).

How/where do you code or record the patient has had this review?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

These reviews are recorded and coded within the general practice records (Vision/EMIS).

Lucy Little, Lead Clinical Pharmacist (Annandale & Eskdale), NHS Dumfries and Galloway:

Feedback was also provided to the referrer/ stakeholders where applicable.

Really encouraging to see referrals for meds reviews coming from social care sector, was there any training beforehand for this sector?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

No specific training for this project but we did have lots of discussion with the teams and met and still meet sometimes with the teams on the daily flow huddle on MS Teams.

Individual practices also have Frailty MDTs including social care, so this was another source for referral and an opportunity to discuss expectations of reviews.

How did you advertise the referral pathway throughout your organisation or in community hubs?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

We met with the managers of all the teams, then more meetings with care managers regarding the practicalities. We then shared the link.

Is it possible that family members assisting in medication administration reduced formal care visits?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

Yes definitely. A few patients and family members were already administering their own medication despite time allocated. We also took the opportunity to discuss the reasons for the medication and dose timings.

Were bloods satisfactory following the medications reviews? Have bloods been rechecked 3 months or so on?

Christine Thomson, Lead Pharmacist Primary Care, Moray Health and Social Care Partnership and Elaine Mackintosh, Primary Care Advanced Pharmacist, Moray Health and Social Care Partnership:

All results were checked and acted upon.

We have regular recalls in birth month set up by the practice.

We use our electronic messaging system to ensure we pick up a review of the patient when appropriate by making a note to ourselves regarding appropriate timescales and bloods etc. All patients are recalled through our Vision IT system for bloods monitoring and again if we wished to intervene outwith the regular recall, where we use a self-reminder.