BackgroundHospital dispensary consultations usually focus on telling your patients how to take medicines. However, patient views are not always considered. We suggest that the value of a consultation lies in helping patients get the best health outcome from their medicines and this requires more than education. Pharmacy teams need to think differently about the way in which consultations are undertaken in order to improve effectiveness of medicines.ObjectivesTo explore development of patient-centred consultations in a hospital dispensary environment using a health coaching approach.MethodIn April 2014, London North West Hospitals NHS Trust Pharmacy Department commissioned a 2-day health coaching course for 18 pharmacists to improve patient focus in consultations. Using learning from the course and knowledge of dispensary processes, a flow chart was created to support management of the three categories of patient. Pharmacy staff trained to tailor their consultation to patient need using a coaching approach, including use of principles of the 4Es (Explore, Educate, Empower, Enable), a pharmacy-based model for short consultation.ResultsPreliminary findings from the new approach included improved staff satisfaction, improved skill mix and positive feedback from patients. The main perceived disadvantage of using the above consultation style was the fear of increasing the time for consultations, however, this appears unfounded. A need for a dedicated counselling area to improve privacy in consultations was identified.ConclusionsProvision of a patient-centred consultation framework in a dispensary environment, using a coaching approach, has improved focus on patient needs, continuing the journey towards patient-centred care.
Objectives
This is a retrospective study that set out to assess the safety, feasibility, and cost saving of the temporary relaxed blood test monitoring for patients on methotrexate under the rheumatology service, that was rolled out during the coronavirus pandemic.
Methods
This is a single-centre study that reviewed the blood tests of all patients who received a methotrexate prescription from the trust between December 2019 and November 2020. After the application of inclusion and exclusion criteria, the blood testing intervals and findings were analysed and collated. The cost of the blood tests was obtained from the laboratory.
Results
1194 patients were identified to have received a methotrexate prescription. After applying inclusion and exclusion criteria, 462 patients were included. Of these, 395 (85%) patients had a blood test within the standard 3-month schedule. 67 patients had blood tests within the relaxed blood monitoring schedule. 6 patients had an abnormality identified on their blood tests, but no harm was caused by any of these abnormalities. The intervention resulted in at least £1,187 cost saving from the blood test costs alone.
Conclusion
Methotrexate is a widely used steroid-sparing agent that requires regular blood test monitoring to reduce adverse outcomes for patients. During extraordinary circumstances such as a pandemic, relaxing the interval between monitoring blood tests in stable patients is a feasible intervention. A relaxed monitoring blood test interval for a set period is safe, achievable and cost-effective
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