Telepharmacy & CKD – A Making Tracks Investment

Strategy Laura Johnstone

Pharmacist Cairns Hospital Renal Unit

August 2016

Outline

• Introduction • Methods • Results • Key Message

INTRODUCTION

Chronic Kidney Disease • 1.7 million Australians affected • 1.5 million don’t even know they have it

• $32.4 million per year to the health system - 5,000 hospital admissions - 110,000 doctor visits

CHHHS

TCHHS

Aboriginal and Torres Strait Islander Peoples

• Up to 4 times as likely to have late stage CKD • Those living in remote areas have up to 20

times higher incidence of end-stage renal failure

AND • 30 years younger

Making Tracks Investment Strategy

• Original publication in 2010 “Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033” • Launched 2015 - 2018 “Making Tracks investment strategy”

Making Tracks Investment Strategy

‘Preventing ill-health, improving diagnosis and early intervention, and better management and treatment of illness through the use of culturally and clinically effective healthcare.’

Making Tracks Investment Strategy

Priorities • Importance placed on preventative strategies • Multidisciplinary management for minimising

chronic disease • Improvement of health services by

implementing initiatives that increase access

Telepharmacy and CKD

• 3 Queensland Health staff members associated with the role

- Administration Officer - Clinical Nurse - Clinical Pharmacist

Aims of Telepharmacy and CKD • Increase access to a clinical pharmacy service • Contribute to reducing the burden of chronic disease • Deliver individualised and community-based CKD

management education • Improve the prevention, education, early detection

and diagnosis, treatment and self-management of CKD.

• Reduce hospitalisation rates for Aboriginal and Torres Strait Islander people with CKD.

METHODS

• Identification

• Appointment scheduled with site

• Appointment letter

• Telehealth Brochure

Telepharmacy Structure • Consent • Introduction • Attendees • Observations • Blood results • Medication review • Survey • Conclusion

Pharmacist documentation

• Integrated Electronic Medication Record (ieMR)

• Software for Specialists (Audit4) • Enterprise wide Liaison Medication System

(eLMS) • Mail/Fax/E-mail to local clinician

RESULTS

Results • Reporting period January to June 2016 • 129 booked telehealth appointments

• 82 successfully completed • 61% of patients identified as Aboriginal or Torres

Strait Islander

Results

• 667 Pharmacist interventions • Average of 8.1 per patient • 93.9% received education

Interventions Key

Code: Meaning: Code: Meaning:

IWS Indication Without Drug FRD Failed to Receive Drug

DWI Drug Without Indication LAB Inappropriate Lab Monitoring

IDS Improper Drug Selection MRD Medication Record Discrepancy

UD Under therapeutic Dose IE Inadequate Patient Education

OD Over therapeutic Dose IC Inadequate Patient Compliance

ADR Adverse Drug Reaction SI Medication Supply Issues

Results

Intervention: IWS DWI IDS IDI UD OD ADR LAB MRD IE IC

Total: 57 21 17 14 32 28 13 71 322 26 36

Yearly Growth

Year of reporting period OOS Number of Pharmacy Intervention

2015 38 147

2016 82 667

Satisfaction Survey

Survey Results

56.5%

41.2%

2.4%

Overall Experience:

Very Satisfied:

Satisfied:

Average:

KEY MESSAGE Telepharmacy is an invaluable health service to prevent CKD progression onto ESRD.

Patients with CKD living in rural and remote areas have a requirement for increased investment to promote awareness and provide education to prevent progression of this silent disease.