Views of General Practitioners and Pharmacists about the New Medicine Service Dr Asam Latif Research Fellow School of Health Sciences, University of Nottingham
What is the New Medicine Service? A remunerated pharmacy service that provides support for people prescribed a new medicine to improve medicine adherence (hypertension, asthma / COPD, diabetes, antiplatelet /anticoagulant) Engagement Following prescribing of a new medicine patient is offered service (GP / self referral) Intervention 7-14 days : Assessment of adherence, identify problems, determine the patient s need for further information and support (Telephone or face-to-face) Follow-up 14-21 days : Pharmacist provides advice and further support
NMS Study Objectives Evaluate the cost-effectiveness of the NMS from an NHS perspective to inform decisions about continuation of the service Explore operation of the NMS to determine acceptability to patients, pharmacists and GPs, determine indicators of successful implementation, generalisability and replicability across four therapeutic groupings in a range of pharmacy settings
Study Design
Qualitative Method 47 pharmacists (61 pharmacies) interviewed about their experience and implementation of the NMS (27 full interviews and 20 shorter exit interviews) GPs whose patients were involved in the qualitative work stream along with a convenience sample of GPs in the study areas were invited (n = 11) Protocol for the New Medicine Service Study: a randomized controlled trial and economic evaluation with qualitative appraisal comparing the effectiveness and cost effectiveness of the New Medicine Service in community pharmacies in England: Trials 2013, 14:411.
GP Views So by the time you ve done your prescription, there isn t this in-depth thing about the medication GP, Male, 26 years qualified GP, Female, 6 years qualified We have one of these pharmacists who comes half a day a week... who help us if we re trying to change people on a particular medication to one that s cheaper or better or if we re trying to meet a particular guideline then the role of the pharmacist is quite pivotal
Awareness and Integration I mean, should I have heard about it? GP, Male, 31 years qualified GP, Female, 8 years qualified The pharmacists mentioned it to us, I hope I m talking about the same service, this is where they review patients with more than four drugs are discharged from hospital? But I think it is duplicating things a little bit and perhaps there is a benefit in that because reinforcement twice is better than once maybe. GP, Male, 24 years qualified
The Pharmacists View on the NMS Nearly all the patients thank you for the call and often the words heard are 'thank you for showing some interest pharmacists were just seen as a supply instrument now they re to talk to and ask questions and get information out of Pharmacist Male, 52 years, Independent Pharmacist Male, 40 years, Large Multiple With all these extra services we re engaged with I think we re very accessible if patients do have a problem with their medication they tend to ring us before they ring their GP
NMS Collaboration One of the doctors said let the doctors do their job and the pharmacists do their job this particular doctor just said that if there s any problem you just come to the doctor, don t go to the pharmacist, he doesn t like pharmacy intervention at all Pharmacist Female, 53 Small Multiple Pharmacist Female, 58 years Independent I spoke to Dr X He was quite keen on the service, but not for the diabetics, he didn t see that there was any need for pharmacy to get involved with that because he said our nurses will do that
Barriers to Patient Recruitment The main problem of me signing up for NMS is Oh I m going to see the doctor anyway in two weeks time, or the doctor is going to check on me anyway. So they don t see the problem or the need for it Pharmacist Female, 28 years, Large Multiple Some say it s not your responsibility it s my GP s, you re just here to dispense my medication Others say I m going to go and see the doctor in two weeks time, I don t necessarily want to inconvenience you, that sort of thing Pharmacist Female, 47 years, Large Multiple
Discussion The Health and Social Care Act 2012 placed integration of health and social care at the heart of policy reforms. Introduces duties for NHS England and CCGs to promote joined-up services. The current isolation of the NMS in the care pathway has the potential to cause confusion for patients. On the one hand, patients may be told by the prescriber to return after four weeks from initiating a new medicine for review and then being told by the pharmacist to have a discussion with them in the intervening period.
Implications and Recommendations The current awareness of pharmacy services in primary care is limited and may be a lost opportunity to improve patients use of medicines. The DH may wish to discuss with GP system suppliers ways in which prescriptions can be endorsed to show that a new medication has been prescribed. An effective referral pathway would allow pharmacists to focus on the delivery of the NMS, rather than spending their time pursuing recruitment or assessing whether the patient is eligible to receive the service.
Acknowledgements All the participants who participated in this study NMS evaluation team: Prof. Rachel A Elliott, Dr Matthew Boyd, Prof. Justin Waring, Ms Deborah Watmough, Prof. Nick Barber, Mr Rajnikant Mehta, Mr Antony Chuter, Prof. Anthony J Avery, Dr Lukasz Tanajewski, Dr James Davies, Dr Nde-Eshimuni Salema, Mr Georgios Gkountouras, Mr Christopher Craig. Email: Asam.Latif@nottingham.ac.uk