Clinical pharmacists now trained to prescribe medicines explain how this helps their health care teams and patients
Leanne Te Karu is a pharmacist prescriber working predominantly in Māori communities – specifically in general practice in Turangi and Papakura.
Leanne works alongside GPs, nurses of all scopes, kaimahi and practice staff to ensure optimal medicines management. She prescribes for chronic conditions and aims to deliver what she terms ‘whānau owned healthcare.’
“If we consider the many steps required to attain ‘optimal medicines management’ we have to make sure it is multi-dimensional and is premised on equity. Whether a person feels able/is able to access a prescriber and have a medicine prescribed factoring in ‘best practice’ through to whether the person administers the medicine as prescribed and then whether the medicine is monitored appropriately requires a systematic and focussed approach.
“Many times, there is no evidence base to make prescribing decisions for the person in front of you considering all their individual circumstance. I consider it an honour that people allow me to be part of this decision making process“ says Leanne, who is of Muaūpoko/ Ngāti Rangi descent.
A hospital clinical pharmacist for more than 25 years, Di Wright is part of the paediatric health care team at Taranaki Base Hospital. Being able to prescribe medicines is a "logical progression", she says.
Training involved post-graduate study through the University of Otago and a 150-hour practicum that included ward rounds and outpatient clinics. "It made you think about all of the processes involved in reaching a prescribing decision and the need to take personal responsibility for them," she says.
Her role now focusses on optimising therapy for infection and pain management, and specialist prescribing for neonates.
Having a pharmacist prescriber on the team helps provide more efficient and effective patient care, Di says. Changes in medication can be made without the need to wait for doctors, and the discharge process is faster.
“In terms of how my work has benefitted patients – my ability to prescribe has led to the faster delivery of optimal patient care for the paediatric patients I work with.”
In her role, this can cover a variety of processes e.g. medication dose adjustment, recharting of medication charts, changing of antibiotic therapy once sensitivities are known and writing discharge prescriptions to allow patients to be discharged sooner.
Kerry Muller qualified as a pharmacist prescriber in (2013) a role that developed from her extensive experience as a clinical pharmacist in secondary care, then as a Clinical Advisory Pharmacist within the large Hutt Valley PHO, Te Awakairangi Health Network; and also on-site as a pharmacist facilitator within one general practice.
Kerry says her work focuses on patients being at the centre of the care. Managing a long term medical condition can be challenging, and she says working alongside a patient’s journey and offering new resources to manage their medicines is key to staying healthy.
“The addition of a pharmacist prescriber in general practice is all about improving patient care delivered within an integrated team environment,” says Kerry. “The ability to not only advise on medicine management, but implement the changes is key to reducing workloads on busy GP resources.”
Analysis of data from Kerry's weekly clinics demonstrates a significant and progressive impact on clinical markers (for example HBA1c, blood pressure and cholesterol). Patients continue to report greater understanding of medicines, improved adherence and feeling more engaged in the decision making process towards attaining clinical targets and lowering their cardiovascular risk.
Pauline McQuoid works for Medwise, a DHB-funded clinical pharmacy service in the Bay of Plenty. Medwise pharmacists visit patients in their home to assess and review medication to make sure it’s appropriate, effective and safe.
The interface from secondary to primary care is well-recognised to be a high-risk time for medication errors. As a pharmacist prescriber, Pauline can now resolve any discrepancies promptly when she identifies medication errors with a patient’s discharge medications. This reduces the risk of the patient experiencing any problems as a result of the medication error.”
Pauline says another useful application of pharmacist prescribing is fine-tuning and adjusting medication doses to obtain maximum benefit from medication.
“An example of this is a patient with poorly controlled diabetes and depression who was referred to Medwise for medication support. Her GP had prescribed antidepressants but she didn’t want to take them because she had tried them before and didn’t think they helped.”
“She agreed to try a different antidepressant so I visited her each week to review her and gradually increase the dose to an effective amount. Her mood improved, she got her driver’s licence and a part-time job which helped build confidence. She became motivated to lose weight which improved her diabetes management so we were able to gradually reduce and stop her insulin. Her diabetes is now well-controlled on tablets.”
Additionally, Pauline also works closely with community nurses both in kaupapa Māori and mainstream services.
It’s an exciting time to be working in healthcare with so many new roles and opportunities.
Linda Bryant works in Wellington at Newtown Union Health Service and Porirua Union and Community Health Service, two Very Low Cost Access practices with high needs populations.
Linda’s work as a clinical advisor and prescribing pharmacist has been integrated into both general practices, focusing with the other health practitioners on diabetes, respiratory diseases and gout. This includes proactive planned care as well as managing unexpected care needs.
"The improved access to treatment for Hepatitis C has been a particularly exciting opportunity to improve the health of people with Hepatitis C," says Linda. "Better diagnostics have meant ready identification of those people who are suitable for primary care treatment."
As well as being able to initiate and monitor therapy for this group, Linda’s role as a pharmacist prescriber has helped with patients’ medicines management. Taking an example of a person requiring antipsychotic medicines after the initial 8 weeks, Linda’s understanding of the way medicines interact, and the potential adverse effect of one, enabled therapy to be continued until completion rather than stopped.
"Other benefits of having a pharmacist prescriber in the primary care team has been working with the primary care nurses to collaboratively manage people with chronic medical conditions. Ready access for patients is improved and there's a more holistic approach, initiating and fine tuning medicines as required."