A longitudinal study was carried out on a population of 4,922 patients served by a general practice surgery with three doctors. The purpose was to investigate the opportunity which domiciliary care of elderly and infirm patients offers to UK pharmacists working in primary care. The aims of the study were: - 1) To identify indicators that could be used to identify patients in the community who might benefit from domiciliary pharmaceutical care, and which do not leave patients excluded. 2) To identify specific issues that would lead to better pharmaceutical care 3) To deliver a package of pharmaceutical care to these most "at risk" patients in the population over approximately a year. 4) To evaluate the interventions made considering the viewpoints of all parties found to be stakeholders. 5) To measure the scale of the challenge of domiciliary managed pharmaceutical care in relation to the population in the study. 6) To provide indicators for the development of pharmaceutical care including cost/ benefit and potential training requirements. A simple qualitative study design was pursued, based upon semi-structured interviews and field notes. A cohort of patients (n=149) identified as candidates for domiciliary visiting, represented 3% of the surgery population. After de-selection of unsuitable candidates, visits were made to 100 patients. Three concepts for the organisation of information and three clusters of criteria were identified and developed which would identify 94 out of 100 patients visited. A large number of indicators for pharmaceutical care were identified and described qualitatively under 14 headings. Though typical, these were not claimed as a comprehensive set of issues which could have been encountered. It was generally perceived that more of the pharmacist's interventions produced positive effects than those that were neutral or actually did harm. Some of the interventions were accepted by the GPs as very important, and developing the extended role to include for instance a cardiovascular review clinic; "in house" medication reviews was discussed. Domiciliary visits were deemed useful though the GPs pointed out that making visits was time consuming and, by implication, expensive. Patients reported a high level of satisfaction with the visiting programme. Satisfaction was explored in an attempt to differentiate sociometric issues from professional ones. Rating satisfaction with a domiciliary pharmaceutical service required that specific issues were identified and dealt with which reflected the main concerns of patients about their medicines. Most of the patients' concerns appeared to be centred around multiple medication, widely perceived (in this cohort) to have potential to cause harm. The author recommends that PCGs consider allocating part of the prescribing budget to fund a domiciliary pharmaceutical care service to a small targeted population through community pharmacies. This could be a first step in offering new professional opportunities through community pharmacies and might revitalise some which are currently in decline.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:311077 |
| Date | January 2000 |
| Creators | Coleman, David John |
| Publisher | University of Portsmouth |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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