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Clinical Pharmacists

Who are Clinical Pharmacists?

Meet our clinical pharmacist team

Clinical pharmacists employed by WellSouth have an increased skill set to work directly with patients in a collaborative healthcare team.

Part of their role is to ensure patients are engaged in the decision making process and from this have a greater understanding of their medicines and long term conditions.

What qualifications do Clinical Pharmacists have?

On top of their pharmacy degree, the Clinical Pharmacists will have (or be working towards) a post-graduate diploma in Clinical Pharmacy. Some Clinical Pharmacists will have completed further study such as a Masters in Clinical Pharmacy or the Post-Graduate Certificate in Pharmacist Prescribing.

What do Clinical Pharmacists do?

Clinical Pharmacists focus on medicines optimisation. We focus on best practice, with cost as a consideration, though not the primary focus. The aim is to increase and optimise patient’s adherence to their medication, reduce medication confusion, remove waste and improve patient self-management.

Target population

The Clinical Pharmacist focus is on the following target population groups:

  • Patients with long term conditions and high health needs, such as low health literacy, poor control of long term conditions or adherence issues
  • Maori or Pacific Island population
  • Patients living in Aged Related Residential Care Facilities
  • Patients >65 years living in their own homes
  • Patients with long term conditions that are on multiple medications
  • Tier 2 and 3 patients assessed via “DO the Right Thing”.

What specifically do Clinical Pharmacists do?

  • Medication reviews involving direct contact with individual patients
  • Medicines reconciliation, ensuring an accurate list of medications is maintained especially during transitions in care
  • Targeted risk reduction in specific long term conditions, such as type 2 diabetes, cardiovascular etc.
  • Education to patient and health professionals, either individually or in groups
  • Medication information queries
  • Help with falls prevention at a patient and district wide level
  • Produce the WellSouth Prescriber bulletin
  • Drug utilisation and evaluation, including individual practice and district wide audits
  • Trained to initiate and undertake Advanced Care Plan discussions

How do clinical pharmacists work with patients?

It is about making sure the right patient gets the right choice of medicine at the right time.

The Clinical Pharmacists will undertake a review of patients either in the practice, in their home or at their residential facility. The aim of the reviews are to:

i)  Improve outcomes

ii) Ensure patients take their medications correctly

  • Ensure patients don’t take unnecessary medications
  • Reduce wastage of medicines
  • Improve medicine safety
  • Use evidence based choices for medications
  • Greater patient satisfaction

How do clinical pharmacists work with practices?

  • Reallocation of the general practice workload, with a medication focused set of eyes reviewing patients with long term conditions.
  • Supports “Do the Right Thing” within the practice

How do clinical pharmacists work within the health system?

  • Improving the clinical and cost effective use of medicines.
  • Allowing care closer to home via home visits and residential care visits
  • Reducing pressure on urgent and emergency care departments by preventing avoidable admissions via timely review of medications and undertaking medicines reconciliation.
  • Fewer aged residential care facility admissions

Why utilise a Clinical Pharmacist?

There are a number of benefits to general practice of having a Clinical Pharmacist working alongside the healthcare team.

These include:

  • Highly qualified unbiased advice
  • Different set of eyes/focus
  • Collaborative decision making
  • Increased confidence within practice to manage polypharmacy
  • Help and guidance on de-prescribing
  • Source of information on constantly changing evidence and guidelines
  • Availability of medicines information
  • Co-ordination of multiple prescribers
  • Undertake education and in-services
  • Contribute to quality improvement of the practice
  • MOPS audits, cornerstone accreditation support with review of medication policies and standing orders.

Having a Clinical Pharmacist as part of the multidisciplinary team may also mean that GPs can focus their skills where they are most needed, for example, on diagnosing and treating patients with complex conditions.

Benefits to patients of referral to a Clinical Pharmacist

A Clinical Pharmacist can provide the following benefits for patients

  • A patient focused approach
  • A different focus- we ask different questions
  • Co-ordination of multiple prescribers
  • Address medicine benefit vs harm
  • Reduce medicine complexity.

How can Clinical Pharmacists help with Aged Related Residential Care (ARRC) Facilities?

One of the aims of Clinical Pharmacists is to reduce the burden of polypharmacy and therefore improve outcomes for patients in rest homes.

We also aim to reduce falls and prevent adverse effects of medication, therefore helping to keep the patient out of ARRC facilities.

ARRC facilities can utilise Clinical Pharmacists to:

  • Undertake a medicine therapy assessment prior to residents 3 monthly reviews.
  • Undertake medicine reconciliation on admission to the ARRC facility
  • Undertake medicine quality initiatives and projects
  • Provide education and in-services for staff.

What do Clinical Pharmacists need to work effectively with your practice or service?

To be fully integrated into the healthcare teams Clinical Pharmacists need access to other healthcare professionals and all record systems.

Outcomes from clinical pharmacists

Within the practice working alongside the Long Term Condition Nurse, Clinical Pharmacist,  GP & Practice Nurse – patient now withdrawn from benzodiazepines, HbA1c was 135 now 61 & expect to be low 50s at next test. Patient referred to and has attended DESMOND & is feeling (and looking) much better than he did previously.

An 84 year old ARRC facility resident. Clinical Pharmacist reviewed her medication because staff had highlighted that her peripheral vision was not as good, often bumping into objects and particularly dizzy and unsteady on her feet. On review Clinical Pharmacist noted she appeared ‘spaced out’ and swaying back and forth constantly trying to rebalance herself.   Gabapentin 100mg mane had been prescribed for a week’s trial to help with her pain. Discussed with the doctor who stopped it with immediate effect. Reviewed a week later and she was orientated, aware and stable on her feet.

Doctor referral for 86 year old patient with multiple medications, hyponatraemia, poor renal function and NSAIDs for osteoarthritis.  A comprehensive medicines review undertaken at the patients home. Recommendations back to the GP and actioned include; stopping NSAID and replace with regular paracetamol, and add in topical capsacian for hands.  Diuretics stopped to improve hyponatraemia.  Switched from ACE-I to ARB to see if this improves persistent cough which is a major issue due to pain from non-union of a sternum following cardiac surgery.  Patient is feeling well, awaiting lab results in 4 weeks to check BNP and sodium levels Pharmacist prescribers


A number of WellSouth Clinical Pharmacists are also Pharmacist Prescribers. Pharmacist Prescribers are specialist pharmacists with extra training and qualifications to prescribe medications as part of the healthcare team. Diagnosis and overall patient management remains the role of the medical practitioner. Once fully integrated into the healthcare team, the Pharmacist Prescriber can improve timely access to medicines, whilst enabling self-care and self-management of long term conditions.

Pharmacist Prescribers can take responsibility for managing patients with chronic long term conditions within the primary healthcare team or work collaboratively with GPs and/or practice nurses to manage patients with long term conditions.

Case example of a pharmacist prescriber role

82 year old European/Pakeha NZ male patient with chronic Heart failure – secondary to ischaemic heart disease. Also has a diagnosis of AF and type II diabetes.

Background – poor knowledge with regard to his heart failure. This condition had the biggest impact on this patient.  He loved to walk each day; he was upset and a bit angry when he had an exacerbation of his heart failure earlier this year as he frequently presented to his GP with shortness of breath on exertion and coughing. He could not understand why his GP was unable to fix it.  He believed no-one tried to help him until he was coughing up blood which he believed was his lungs rather than his heart causing the problem.

Treatment Plan

  • Follow-up consultation at home for 90 minutes  to educate with regard to cause, signs and symptoms and management of his heart failure
  • Stop clopidogrel - Cardiology discharge for PCI stated dual antiplatelet therapy (DAPT) for 12 months then aspirin life-long.  (Aspirin has since changed to dabigatran when AF diagnosed)
  • Change simvastatin 40 mg nocte to atorvastatin 40 mg mane
  • Reduce felodipine 10 mg mane to felodipine 5 mg mane for 1 week then stop
  • Initiate candesartan (as more appropriate with heart failure) on cessation of felodipine at 4 mg daily, titrated every 2 weeks to the highest tolerated maintenance dose. 

WellSouth Prescriber

Once a month the Clinical Pharmacists produce a one page bulletin highlighting latest evidence, medication related updates or patient focused solutions.

These are emailed out to all GPs, practice nurses and practice managers on the WellSouth database, alongside community pharmacists and aged care residential facilities.

Click on the link below for past editions.

 

How do you arrange a Clinical Pharmacist to be part of your practice or ARRC Facility?

Clinical Pharmacists are available across the region, including rural areas. As availability of Clinical Pharmacists allow, practices are notified to submit an Expression of Interest to have a Clinical Pharmacist working within their healthcare team. For further information about this contact Angela Harwood, Team Leader.

Practices can also submit, via the portal, a referral for individual patients who meet the target population above to be reviewed, either in the patients home or practice.

ARRC Facilities should contact Angela Harwood, Team Leader for more information about a Clinical Pharmacist working within their facility.