The potential role for a pharmacist in a multidisciplinary general practitioner super clinic

Background

The Australian government’s General Practitioner (GP) super clinics programme aims to provide well-integrated, multidisciplinary, patient-centred care for people with chronic disease. However, there is no research into the current role of pharmacists in this setting.

Aims

To explore the perspectives of GP super clinic staff on current and potential (future) pharmacist-led services provided in this setting.

Methods

Individual interviews (facilitated using a semi-structured interview guide and thematically analysed) were conducted with purposively sampled staff of a GP super clinic in a semirural location in the state of New South Wales, until theme saturation. Participating staff included (n=9): three GPs, one pharmacist, one nurse, one business manager, and three reception staff.

Results

Three themes emerged conveying perspectives on: working relationships between staff; a pharmacist’s current role; and potential future roles for a pharmacist. All clinic staff actively engaged the pharmacist in their “team approach”. Currently established roles for home medicines reviews (HMRs) and drug information were well supported, but needed to be expanded, for example, with formalised case conferences between GPs, pharmacists, and other staff. New roles needed be explored in auditing medication use, optimising medication records, specialised drug information, dispensing, and prescribing. Although GPs had differing views about opportunities for pharmacists’ prescribing in this setting, they saw several benefits to this service, such as reducing the time pressure on GPs to enable more effective consultations.

Conclusion

Results suggest a pharmacist’s services can potentially be better used within the multidisciplinary super clinic model of care to address current gaps within the semi-rural practice setting. Any future role for the pharmacist could be addressed as part of a formalised, strategic approach to creating an integrated healthcare team, with attention to funding and government legislation.     

Effective administration of recombinant tissue plasminogen activator (rt-PA) during resuscitation of a post partum patient with massive pulmonary embolism.

Severe pulmonary embolism with cardiac arrest occurred half an hour after the 5th spontaneous delivery in a 34-year-old multipara. Standard resuscitation for 30 minutes remained ineffective. Only after Actilyse rt-PA infusion the patient's state improved. She regained consciousness on the third day. After 32 days of hospital treatment the patient was discharged in a generally good condition. Today, 5 years after the described event her state of health is very good.     

A qualitative study on the adverse reactions of mass treatment for lymphatic filariasis in Orissa,India

ObjectiveTo describe the perceptions of community members and programme partners regarding severity, management and impact of adverse reactions on mass drug administration (MDA) compliance.MethodsBased on various qualitative data collected from five districts of Orissa, India, where MDA had been implemented during 2002 and 2004. The qualitative surveys included focus group discussions with community members and health workers, and semi-structured interviews with key informants in the community, medical officers at primary health centres, district level health officers and private practitioners.ResultsIt showed that many people suffered from adverse reactions, though the reactions were not serious. The paper reported different ways of management of adverse reactions at the community level. The impact of adverse reactions on MDA compliance was serious, as many people did not consume the drug due to fear of adverse reactions. The rumours of adverse reactions and news in media deterred people from consuming the tablets.ConclusionAll categories of respondents indicates the need of more information to address the problem of adverse reactions during MDA. The present paper warrants incorporating the messages on adverse reactions during health communication and social mobilization campaigns of MDA.     

Decision-making around antithrombotics for stroke prevention in atrial fibrillation: the health professionals’ views

International Journal of Clinical Pharmacy - Background For stroke prevention in patients with atrial fibrillation (AF), the decision-making around antithrombotic therapy has been complicated by...