An action research evaluation to understand and inform the role of the Integrated Care Pharmacist across health and social care
Introduction A research study was commissioned to understand and inform the new role of an Integrated Care (IC) Pharmacist, founded to work as part of the health and social multidisciplinary team (MDT) within the IC program for East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG). Aim The aim of the study was to understand and inform this new role of the IC Pharmacist for ELRCCG and how to develop and sustain such a role. Methods A participatory mixed methods research strategy, which aligns with pragmatism as a philosophy was used. The qualitative arm of the mixed methods was predominantly underpinned by phenomenology and included interviews with two IC patients and seven professionals who were a core part of the integrated MDT and one focus group. For the quantitative arm, key performance indicators(KPIs) documented in line with the sponsor evaluation policy were analysed. Findings The six themes derived from the qualitative methods were: teamwork; accessibility and visibility; resources and enablers; reflection on the role functions; Impact of the role and evaluating performance of the role. For the quantitative results, all the KPIs were achieved, including a return of investment of 311%, a reduction of polypharmacy by the de-prescribing of 54 drugs, the completion of clinical medication reviews in 100% of patients and repeat prescription reviews in 37% of patients and the provision of four medication training sessions for the IC coordinators. Discussion The findings support existing literature by qualitatively and quantitatively showing how the role functions and positive outcomes achieved by pharmacists in integrated primary care roles can be extended to social and health integrated care teams. Role functions highlighted include provision of pharmaceutical care to patients and training and education to staff. Positive outcomes delivered by the IC pharmacists include participant empowerment and bridge building between health and social care professionals.Furthermore, this study contributes to existing knowledge by identifying enablers and showing how they can optimise these outcomes. A key enabler was to fully embed the IC pharmacist role within a health and social MDT and co-locating the MDT at a GP surgery, instead of remote offices . Ensuring effective teamwork which is facilitated by a shared agenda, role understanding, respect, accessibility and visibility is another important enabler. A third enabler identified as crucial to sustain the role, is funding to transform the model to a fully embedded GP hub pharmacist and technician team, to ensure holistic staff capacity. Finally, the study highlighted that the role could be evaluated through stakeholder feedback as well as the utilization of admissions avoidance figures after adjusting for assumptions. Conclusion In line with action research, both action and additional knowledge were achieved. Action was achieved by ultimately transforming and expanding two roles to twelve teams of pharmacists and pharmacy technicians. Additional knowledge contributed include the views of key stakeholders across health and social carer, including patients, regarding what exactly the IC pharmacist role is, how it is delivered and could be adapted to increase sustainability, what outcomes it delivers and how they can be evaluated. Further research is required to inform which of the models would be best suited for the local population.
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