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6 - Interface of care and communication
- Molly Courtenay, University of Surrey, Matt Griffiths, University of the West of England, Bristol
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- Book:
- Medication Safety
- Published online:
- 22 January 2010
- Print publication:
- 01 October 2009, pp 83-96
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Summary
Objectives
Identify the types of medication problems that arise at transition points in primary healthcare.
Explore the reasons why these problems occur.
Discuss possible methods of improving patient safety.
Summary
Interfaces and transitions relating to medicines use occur across healthcare settings and between healthcare professionals. This chapter focuses on primary care where the majority of medicines are prescribed and used. Medicines related problems (MRPs) have effects ranging from inconvenience, through impaired quality of life, to serious harm. There is increasing evidence that many MRPs are caused by communication failures and that future solutions need to include tackling the human causes of inadequate communication. Four medicines (anticoagulants, diuretics, non-steroidal anti-infl ammatories and antiplatelet medicines) are responsible for half of the medicines related hospital admissions and many of these episodes could be prevented with improved surveillance and interventions in primary care. Possible solutions are discussed including proactive monitoring in partnership with patients (including clinicians not making assumptions that someone else has ensured safety), the use of medicines review, and methods of strengthening patients' and carers' knowledge. All healthcare professionals should be vigilant and not assume that the correct prescription, supply, appropriateness and safety of medication has been checked already. Clinicians need to give adequate information to patients and check the patient' knowledge. All healthcare professionals should be vigilant and not assume that the correct prescription, supply, appropriateness and safety of medication has been checked already. Clinicians need to give adequate information to patients and check the patients or carer's knowledge at each stage. Patients should be regarded as experts in their own conditions and be encouraged to fl ag up any concerns.
Joining Up Self-Care: evaluation of a PCT-wide programme of support for self-care
- Alison Blenkinsopp, Jeremy Holmes, Gopa Mitra, Mike Pringle
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- Journal:
- Primary Health Care Research & Development / Volume 10 / Issue 2 / April 2009
- Published online by Cambridge University Press:
- 01 April 2009, pp. 83-97
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Background and Aim
Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme.
MethodsThree self-care support modules for members of the public, together with a training course for primary care teams, were developed with, and implemented in, one PCT. The modules related to disease prevention (community-based coronary heart disease (CHD) prevention), care of people with long-term conditions (a disease-specific self-care skills training course for asthma) and the management of minor ailments aimed at mothers of children aged 3 months to 12 years (the ‘Pharmacy First’ service plus information booklets and campaigns). Postal questionnaires were completed by participants in CHD prevention (178), management of asthma (76) and minor ailments management (92), and by controls. A general population survey (n = 540) provided a comparison group for the CHD module and assessed general awareness of local self-care support. Four focus groups were held with mothers of young children. An audit of general practitioner (GP) records was conducted for consultations for minor ailments. Structured telephone interviews were conducted with 51 local health professionals and nine members of staff from the PCT.
ResultsParticipants in the CHD module reported significantly more risk-reducing behaviours. Participants in a disease-specific Expert Patient Programme (EPP) for people with asthma rated the course positively, were subsequently more confident about discussing asthma with their doctor and had fewer concerns about their asthma medicines. Most users of the ‘Pharmacy First’ minor ailments scheme reported positive feedback and an intent to use the service again in the future. There were no significant differences in numbers of GP consultations for minor ailments between intervention and control groups. Health professionals were generally positive about encouraging self-care. Many felt they were already doing this but had insufficient time to implement it. A Local Enhanced Service (LES) was successful in engaging local general practices with self-care. Some organizational development relating to self-care occurred within the PCT but integration across different directorates was not achieved.
ConclusionsThe JUSC programme was associated with changes in self-reported CHD risk reduction behaviours, in confidence to manage asthma and fewer concerns about medication, and with more positive attitudes towards consulting a pharmacist for minor ailments. Key principles for future PCT self-care strategies were identified. Further work is needed to embed support for self-care across the PCT as an organization.