The Medication Assessment Centre: A New Resource for Students, Patients and Practicing Pharmacists

Eric Landry, BSP, ACPR

Derek Jorgenson, BSP, PharmD, FCSHP

Learning Objectives

1. Describe the history, structure and function of

MAC (re: pt care process, student experience)

2. Share current evaluation of MAC

3. Explain the potential value of MAC to practicing

pharmacists

4. Describe how we hope to integrate MAC into

our new PharmD program at USask

What is Medication Assessment Centre (MAC)?

New initiative from College of Pharmacy and Nutrition at the University of Saskatchewan

Our Vision

To demonstrate national

leadership in the education

of health professionals while

optimizing the health of our

community

What Makes MAC Unique? 1. Pharmacist clinic with no

dispensary

2. Physically located in the pharmacy school (close to lecture halls, labs, student lounge)

3. Students take leadership in providing clinical services with real pts (in between classes!)

4. Consultant pharmacist model

5. Supervised by faculty

History of MAC – Initiated in 2011

MSc thesis – Julia Bareham 1. Survey of family physicians in

Saskatoon to gauge interest and collect ideas for how to structure the clinic (Jan 2011)

2. Created a 1 day per week pilot clinic (mid 2011), which ran for 17 months

3. Program evaluation of pilot clinic completed in late 2013, which informed current clinic structure

MAC – Current Campus Location

March 2014 – began offering services 5 days per week

Health Sciences building, U of S campus

Patient Services Currently Provided by the Medication Assessment Centre

• Comprehensive Medication Assessments

• Group patient education sessions

• Hypnotic tapering / insomnia cognitive

behavioural therapy

• Smoking cessation

Where do our patients come from?

1. Family physician referrals – 50.0%

2. Patient / family self-referrals - 37.5%

3. RN / NP referrals – 5.7%

4. Pharmacist referrals – 2.3%

5. Specialist physician referrals – 2.3%

6. Dietician referrals - 1.2%

7. Psychologist referrals – 1.0%

The typical process of a patient encounter

1. Referral received

2. Pharmacist one on one appointment (can be via phone)

3. Patient education / adherence support provided

4. History collected (interview, MD chart, labs, etc)

5. Assesses for opportunities to optimize med regimen

6. Meet with pt (for 2nd appt) to discuss recommendations

7. Consult letter to primary prescriber (cc: other HCPs)

8. Follow up appt (usually phone) to assess med changes

9. Additional follow up (if needed)

10. Patient recalled for annual follow up (after 1 year)

Student Integration into MAC

1. Volunteer (1st – 3rd yrs)

2. SPEP rotation (4th yrs)

3. 4-1 student/faculty ratio

4. Peer teaching model

5. Remote supervision

6. Reflective learning

MAC EVALUATION

Patient Care Stats (1 year)

• Built up roster of ~225

patients in our practice

• Pts are elderly (mean 71

years) and 67.9% female

• On average, 13.3 chronic

meds and 9.2 medical

conditions per patient

• Mean of 5.1 drug therapy

problems per patient

Patient Interview Data

• One-on-one, semi-structured, anonymous telephone interviews conducted with 9 patients (during the MAC pilot phase)

• Performed by interviewer external to MAC team

• Recorded and transcribed verbatim

• Thematic analysis used to identify key themes

Patient Interviews: Key themes

• Overwhelming satisfaction and support

• Appointment process

• Medication regimen optimization

• Overcoming drug coverage barriers

• Patient education

• Suggestions to improve logistical aspects (signage, directions to clinic, number to call if they had questions, process for re-scheduling)

Patient Survey Data

• March 1/15, initiated postal survey to all patients

who have completed our service

• Have ~6 weeks of initial data to share

• Mailed to 63 patients

• 40 pts returned the survey (63.5% response rate)

Patient Survey Data

I would describe my overall experience at the Medication Assessment Centre as:

• 95.0% (38/40) Very satisfied / satisfied

• 5.0% (2/40) Unsatisfied

I was treated with dignity and respect at the Medication Assessment Centre

• 97.5% (39/40) Strongly agree / agree

• 2.5% (1/40) Disagree

Patient Survey Data

The pharmacist listened to my concerns

• 97.5% (39/40) Strongly agree / agree

• 2.5% (1/40) Disagree

I was involved in the decisions made about my health

• 92.5% (37/40) Strongly agree / agree

• 2.5% (1/40) not sure

• 5.0% (2/40) disagree

Patient Survey Data

My health has improved as a result of the services that I received at MAC

45.0% (18/40) Strongly agree / agree

47.5% (19/40) Not sure

7.5% (3/40) Disagree

Would you recommend MAC to your friends or family?

95.0% (38/40) Yes

2.5% (1/40) No

2.5% (1/40) Not sure

Physician Interview Data

• One-on-one, semi-structured, anonymous telephone interviews conducted with 5 family physicians (during MAC pilot phase)

• Performed by interviewer external to MAC team

• Recorded and transcribed verbatim

• Thematic analysis used to identify key themes

Physician Interviews: Key themes

• Overwhelming satisfaction and support

• Collaborative approach to care

• Thorough and comprehensive collection of patient history and subsequent assessments

• Observed benefits to pt care / health outcomes

• Benefits to their personal practices

• Need to better promote the service

Physician Survey Data

• March 1/15, initiated postal survey to all GPs

who have had a pt complete our service

• Have ~6 weeks of data to share

• Mailed to 50 GPs

• 22 returned the survey (44.0% response rate)

Physician Survey Data

I would describe my overall experience with the Medication Assessment Centre as:

• 95.4% (21/22) very satisfied / satisfied

• 4.6% (1/22) unsatisfied

The Medication Assessment Centre helps me to improve the health of my patients

• 86.4% (19/22) strongly agree / agree

• 9.1% (2/22) not sure

• 4.5% (1/22) disagree

Physician Survey Data

The recommendations and consult letters were helpful

• 100% (22/22) strongly agree / agree

Would you recommend MAC to your GP colleagues?

• 86.4% (19/22) YES

• 9.1% (2/22) NOT SURE

• 4.5% (1/22) NO

Student Data (Sept 2014-April 2015)

1st – 3rd year students

• 56 different students have volunteered

• 131 discreet observations

4th year students

• 6 full-time SPEP students (Jan – April 2015)

Student Impact

• MSc student currently working on a detailed

evaluation of possible student impact (want

to focus on competence and confidence)

• Anecdotal response from students very, very

positive

• Volunteer spots are highly competitive

MAC Evolution – SWITCH Satellite

• SWITCH is an existing interdisciplinary, student run, after-hours outreach clinic in core Saskatoon neighborhood

• One night per week

• Focus on aboriginal health and vulnerable populations

How is MAC a Resource for Community Pharmacists?

• Referral of patients to MAC / shared care

• Development of educational materials and seminars at conferences

• Immersion CE program in development

• Assisting with evaluation of provincial medication review program in Sask

How is MAC a Resource for Hospital Pharmacists?

• Transfer of care, as patients leave the hospital

• Provide ongoing support and follow-up

• Address issues or DTPs which were not possible

to solve during hospital stay.

Integration of MAC into PharmD Curriculum

MAC: The Future

• Detailed evaluation of student impact

• Student peer smoking cessation service

• Focus on high risk acute care discharges

(recently applied for CIHR funding with MUN)

• Enhanced focus on aboriginal health

• Development of immersion CE program for

practicing pharmacists

The MAC Dream Team

• Eric Landry – coordinator / pharmacist

• Jaris Swidrovich – part-time pharmacist

• Katherine Lysak – part-time pharmacist / MSc

candidate leading student evaluation

• Julia Bareham – helped create and evaluate

MAC pilot, team consultant

Discussion and Questions