More Than A Pain In The Big Toe

Transcription

1 More Than A Pain In The Big Toe Organisation Name: Counties Manukau Health Presenter(s): Rebecca Lawn HRT 1520 Innovations Workshops and Awards November 2015, Sydney

2 Key Problem There are more than 16,000 people with diagnosed gout in Counties Manukau Health (CMH) There is large variability in the way it is managed in primary care Poorly managed gout results in unnecessary pain and suffering and avoidable hospital admissions 2

3 2015 Confidential Draft Discussion Document 3 Aim of this innovation To develop a pharmacist led, collaborative gout management service 90% of eligible patients with gout at The Doctors, Ti Rakau* will be enabled to self manage their condition** by 31 st December 2015 * Collaborative partners - patient, community pharmacist, practice nurse and GP **As defined by a reduction in urate at months 3, 6, 9 and 12 and improvement in quality of life measure

4 4 Baseline Data / Current Situation >16,000 patients with gout in Counties Manukau Maaori and Pacific people disproportionately affected Average 360 admissions/year to Middlemore Hospital ( ) Cost > $1million/year (average stay 4 bed Largely preventable with adherence to medicines CMH Manaaki Hauora Campaign provided opportunity to support self management Developing service presents opportunity for community pharmacists to work at the top of their scope and move to providing more clinical services

5 Creating the will Gathering data about gout prevalence and its cost to the organisation and presenting a proposal to develop a new model to improve management of gout in primary care to Rheumatologist, Pharmacy Service Manager and Manaaki Hauora leadership Presenting the proposal to a large healthcare company, who are associated with multiple pharmacies and GP practice s which resulted in an agreement to collaborate. potentially giving access to numerous GP s and pharmacies to test the model Meeting with a GP, community pharmacist and practice nurses at pilot site and discussing the project and what it involves, and how it could benefit their patients

6 First challenge finding a testing site Needed to find a general practice AND pharmacy that were up for the challenge took 6 months! Initial key tasks Find a (willing) colocated GP practice and pharmacy site Gain Ethics Approval Develop and test new processes (identify and recruit patients, flow through system Develop supporting documents (standing order, checklist, training materials

7 Gout from a patients perspective

8 Key changes implemented Secondary drivers Patients Access to information Health professionals Resourced Change concepts & ideas tested Development of self-management support resources in consultation with: Health literacy experts Rheumatologists and other health professionals Patients and whaanau Patients - Access to information & services Health professionals Engagement & Resourced Collaborative Model of Care Transparent communication Health professionals Collaboration & Resourced Use e-shared care platform (accessible to GP s/pharmacist/nurses/patient) Enable collaborative patient management Enable patient self management Use point of care testing to facilitate allopurinol dose titration Remove access to laboratory barrier Ensure optimal dose reached Develop training packages for GP s, pharmacists and nurses to deliver care, including point of care testing, health literacy training. Standardise key messages for patients 8

9 Outcomes to date Patient 1 Non adherent prior to referral to service Colchicine started to prevent gout flares during allopurinol dose escalation Urate reduced after 4 weeks patient adherent Allopurinol dose increased from 100mg to 200mg after 4 weeks Patient enrolled in CMH At Risk Individual (ARI) program Communication between MDT through e-shared care platform Positive feedback on service 2015 Confidential Draft Discussion Document 9

10 Achievements to date Facilitating integration within primary care and between primary and secondary care MDT (GP, nurse, pharmacist) attended a Gout Education Session presented by Professor Gow (Rheumatologist) Patients are enrolled in ARI programme Using Electronic Shared Care used to communicate between MDT Patients receiving self management education Testing urate point of care testing in community pharmacy Patient #1 has had a urate reduction after 4 weeks and allopurinol dose escalation (pharmacist-led)

11 Lessons Learnt Building engagement takes time need to make connections, build trust, provide support There is a need for self management support for patients Integrated care is often talked about but difficult to achieve Having a high profile specialist supporting the project and the GP s has helped with engagement 2015 Confidential Draft Discussion Document 11

12 Contact for this Innovation For more information Contact: Names: Rebecca Lawn Ian Hutchby Confidential Draft Discussion Document 12