Rima Subritzky has lived in Banks Peninsula all her life. Her father was the region’s Chief and also a Māori doctor. So it’s no wonder this doting grandmother wants to stay in her own home and look after her health.
The 85-year-old Rapaki Māori elder is on multiple medications for various health concerns. When things were going astray, Rima decided to speak to her pharmacist.
“They were sending me backwards and forwards from hospital when I wasn’t good,” Rima said.
“I asked [my pharmacist] why certain things were happening and I told him what I thought could be helpful for me.”
For her local Lyttelton pharmacist John Thrupp it is supporting patients like Rima that gives him the most job satisfaction.
Lyttelton Pharmacy has been participating in a feasibility study of a new Medication Therapy Assessment (MTA) Service in Canterbury.
The service is an extension of Canterbury’s Medication Management Service (MMS) which has been successfully running for the past four years. Through MMS, the pharmacist aims to improve understanding of and adherence to medicines regimens; identifying and addressing factors linked to non-adherence as well as minimising pharmaceutical waste.
MTA is the natural extension of MMS and involves an accredited pharmacist performing a systematic, patient-centred clinical assessment of all the medicines currently taken by a patient, identifying, resolving and preventing medication-related problems as well as optimising the effectiveness of medication treatment.
“I was noticing medication issues that needed correcting and picking up things that we could have been doing something about, but we couldn’t. Now we can,” John said.
“Following a 45 minute consultation with the patient, the GP and I talk for 15 or 20 minutes about a particular patient and we come up with a joint plan together about how we’re going to move forward over the next 3, 6, 12 months with that patient. I think it’s a win-win for everyone. It really helps us in our work and it really helps the patient as well to feel they’re getting a real holistic approach to their care.”
John has already completed MTAs for 10 polypharmacy patients like Rima in the small Banks Peninsula community. With medication issues contributing significantly to the number of people ending up in hospital and aged care, the outcome for people’s quality of life can be significant.
For Rima, the MTA assessment uncovered issues around the timing that she was taking the medications, medication efficacy and the risk versus benefit for a number of her prescribed medications. John’s recommendations included rearranging dose times to suit Rima, optimising doses and stopping a number of medications that were no longer required.
This has helped Rima by giving her a simpler more effective medication regimen that aims to help her to remain independent in her own home. Removing some medications also removed the need for home visits for blood taking, saving Rima and her doctor time and money.
“I’m so thrilled that John helped me,” Rima said.
“I said, ‘Oh John, what a difference’.”
“None of my family has ever been put into a home,” Rima said, and she’s determined not to end up in care either.
Gareth Frew, Clinical Leader at Canterbury Community Pharmacy Group (CCPG) (which is delivering the MTA programme in Canterbury) said successes like these are credit to the continued support of the Canterbury District Health Board to enable community pharmacy to deliver more services closer to home and keep people well and out of hospital.
“LEAN principles have been used to free up time and facilitated meetings with other health providers have enabled relationships to develop and more patient focused care to be delivered.
“For MTA to work well it needs true collaboration and communication between the Community Pharmacist and GP,” Mr Frew said.
John agrees. He has freed up 3.5 hours of time he would previously spend on administration and avoidable tasks every week, which he now spends collaborating with the local General Practice to better care for patients with long term conditions and high needs.
John said in summary, prior to the most recent integration project and the MTA pilot, the General Practice and his pharmacy “were two separate places that didn’t really communicate much.
“I was sort of out of the loop but now we communicate regularly to complete MTAs, MMS and other patient centric activities.
“GPs have loved it, patients have loved it. It seems to work so far.”
For more information about the Medication Management Service, visit www.ccpg.org.nz