Two recent prescribing incidents, two adverse outcomes – and maybe one more possible role for pharmacy?
The first was a patient who had suffered a stroke. We’d started treatment for hypertension two years previously, arranged for review a month later, then nothing. He simply vanished off our radar – until we received the ‘CVA, home with care package’ discharge letter.
And the second was a woman who, we now realise, had been over-using her bronchodilator instead of letting us know that her asthma control was going haywire – to the point that she ended up in ITU with a very serious exacerbation.
Both illustrate opposite polarities of the same problem: medication monitoring. With planned review dates and reasonable vigilance, we can only do so much – people will inevitably slip through the net.
We have no easy way of picking up defaulters like patient one - not without more hours in the day and a serious boost to our waning proactive energies. As for patient two, the repeat prescribing clerk might spot excessive use of salbutamol, but it’s asking a lot of non-medical staff to police prescription abuse. And, yes, the computer system probably could be tweaked to prevent unfettered supply, but that creates a whole other set of problems in prescribing inflexibility.
Perhaps this is where you might come in. I doubt you have any more time than us, but at least you have a commercial imperative to chase up apparent defaulters. And as for medication overusers, maybe your shop-front interaction puts you in a better position to spot, say, the average salbutamol junkie. In which case, maybe you could let them, or us, know.
Dr Messenger is a GP trying to negotiate the impenetrable structures and commissioning quagmires of the reformed NHS. Genuinely good friends with his local pharmacist, he offers a GP take on the primary care issues of the day. Please don't shoot, he comes in peace