Author(s): Bryant K.; Parslew R.; Al-Sharqi A.; Bharati A.
Source: British Journal of Dermatology; Jul 2019; vol. 181 ; p. 29-30
Publication Date: Jul 2019
Publication Type(s): Conference Abstract
Available at British Journal of Dermatology – from Wiley Online Library Full Collection
Available at British Journal of Dermatology – from Unpaywall
Abstract:There is a shortage of dermatologists nationally, which has led to increasing pressures on dermatology outpatient services. As a consequence, this can lead to patients on systemic therapy having a disruption to regular monitoring as required by the BAD guidelines. To address this, we looked at a new way of developing outpatient monitoring clinics. The aim is to provide safe monitoring of patients who are stable on systemic or biological medications for the treatment of psoriasis and eczema. Recently, two reports were identified, inter alia, using evidence to find better ways of delivering care for patients, in particular focusing on clinical practice to help deliver better outcomes in times of austerity [Alderwick H, Robertson R, Appleby J et al. Better value in the NHS. The role of changes in clinical practice. Available at: https://www.kingsfund.org. uk/sites/default/files/field/field-publication-file/better-valuenhs-Kings-Fund-July%202015.pdf; Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. Available at: https://assets. publishing.service.gov.uk/government/uploads/system/upload s/attachment-data/file/499229/Operational-productivity-A. pdf (both last accessed 22 January 2019)]. We have developed the use of a specialist dermatology clinical pharmacist who is an independent prescriber to lead some clinics. The clinics were set up to ensure that follow-up frequency and bloodtest intervals were adhered to. Patients are booked in for 3-monthly appointments. During their visits, therapeutic drug and routine monitoring is conducted and Psoriasis Area and Severity Index, Eczema Area and Severity Index and Dermatology Life Quality Index scores are completed, in accordance with the BAD guidelines and facilitated using an in-house checklist. The pharmacist discusses current treatment, modifiable lifestyle factors and any proposed changes to treatment with the patients, including biosimilar switching. During the consultation, the pharmacist prescribes medication as necessary, provides further blood monitoring forms, books the next follow-up appointment and safety netting, documents the visit and dictates the clinic letter. Prior to concluding the consultation, the pharmacist discusses any proposed changes or more complex patient factors with the medical team. This provided the infrastructure to run a service and produced significant benefits. Firstly, the pharmacist in dermatology is upskilled to enhance follow-up care of patients, which in turn has led to a closer working relationship with the dermatology team. Secondly, the pharmacist can track the patient’s biosimilar journey from clinically checking the prescription chart in the infusion unit, to the supply of medicines to reviewing the patient in clinic. Thirdly, the patient has easier access to the pharmacist for medication-related queries, which aids understanding and concordance. We present this to demonstrate a model of maintaining a high-quality dermatology service during a workforce crisis.