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Community Pharmacies

Community Pharmacies across Wales have today (29 April 2014) welcomed the announcement by Welsh Government Health Minister, Mark Drakeford, that the innovative Welsh ‘Home from Hospital’ Medicines Service has been given the green light to continue permanently following the positive outcome of an independent service evaluation which showed the service produced significant benefits to people when they come home from hospital and savings to NHS Wales.

The Discharge Medicines Review (DMR) Service, as it is officially known, was first introduced in Wales in November 2011 following detailed discussions between Welsh Government and Community Pharmacy Wales about ways to use the medicines expertise of community pharmacy to reduce the numbers of people who go back into hospital because of problems with their medicines. The service brings potential patient benefits by community pharmacies and GP surgeries working together to make sure that people leaving hospital continue to receive all the medicines they require to treat their condition and that they fully understand how and when to take their medicines to maximise these benefits. This Ministerial decision now follows an independent service evaluation which was commissioned by Community Pharmacy Wales (CPW) and carried out by a consortium of the universities of Bradford, Cardiff and South Wales.
CPW Chair, Chris James, who is a Pharmacist Director of Carmarthen based Walter Lloyd Pharmacy Ltd, said “I am extremely pleased that the very positive results of the independent evaluation have convinced the Minister that the service should now be incorporated in the contractual framework for community pharmacies in Wales. The success of this NHS service is a reflection of the hard work that community pharmacy teams have invested in the service since its introduction just over two years ago and which the evaluation shows has significantly benefited patients across Wales. Welsh Government and Wales based community pharmacies can be very proud of achieving a practical, innovative and cost effective service to address what the research has shown is an international problem.”
Mr James added: “The results suggest that the service has been most successful where there is close cooperation between community pharmacies and hospitals, especially hospital pharmacies and hospital discharge teams, GP surgeries and social care agencies. We now look forward to working closely with these partners to develop key aspects of the service further now that its future is secured.”
Mr James added: “The news of an additional £280,000 to start to develop electronic discharge advice to community pharmacies is also a welcome recognition by the Welsh Government of how technology linking community pharmacy and secondary care can assist patient care.”
Mr James explained “The case for the continuation of the service is essentially three-fold:

1) A 3:1 return on investment so that for every £100,000 spent on DMR, NHS Wales benefits by £300,000;
2) Medicines adherence, and awareness by patients of the importance of medicines management, and the role of the community pharmacy are enhanced by the service, and
3) The research provides evidence that the service has the capacity to save lives.
In addition the research shows that:
 resources valued at around £3 million were freed up as a result of the service helping to avoid A&E attendances, hospital admissions and drug wastage.
 found a medication error rate of 28.7%, some of which were serious and some even potentially lethal. This means that lives have been saved by the DMR service and that an extension of the service would save more lives.

 The service effectively links secondary and primary care and also has the potential for better links with social care, especially through its reablement responsibility.
Mr James concluded: “DMR puts the medicines reconciliation expertise of community pharmacy, together with our professional pharmacy colleagues in hospitals and GP surgery teams which produces a service shown to be beneficial to patients and to NHS Wales. This professional partnership can be further strengthened in a continued service. The DMR service has not yet reached its full potential and there is significant room for further growth in delivery of the service by the Welsh community pharmacies which will contribute to further patient benefits.”
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The HOME FROM HOSPITAL (DMR) service consists of a series of steps which the community pharmacist will go through with the patient, as well as the GP and the hospital pharmacist. This is all to reduce the chances of the patient having to go back into hospital due to any medicines problems. There are often at least 2 consultations around 10 days apart.

Step 1 - Tell your pharmacy you are home from hospital or ask a relative, friend or carer to tell them.
Step 2 – Give your pharmacy the letter you were given in hospital ready to come home – if you are not able to get to the pharmacy then a relative, friend or carer can do it for you - or you can have a confidential phone consultation with the pharmacist.
Step 3 – the pharmacist will speak to you about the medicines you were on before you went into hospital and any changes made when you were in. This is to ensure you have all the medicines you need and that you have stopped taking any you no longer need. The pharmacist will also explain what your medicines do and how you can get the best results from them.
Step 4 - The pharmacist may then also speak to your GP and to the hospital. This is to make sure your next prescription is accurate.
Step 5 – The pharmacist will speak to the patient for a second time 10 days or so after they have got home. This is to ensure the medicines are continuing to work safely for them.

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