Partners in Disability Care: A Paediatric-Pharmacy Shared Care Model

Aim

To offer an alternative care model for medication reviews in young people with developmental disabilities at the Child Development Service at the Gold Coast HHS, aiming to enhance patient care and clinic efficiency by involving pharmacists, under indirect paediatric supervision, to perform medication follow-ups.

Outcomes

• Reduction in number of paediatrician appointments required per child, which increase the capacity of paediatricians to focus on new referrals to service.
• Enhanced individual care through paediatrician-pharmacist collaboration: more review appointments available, increased timeliness of review, increased capacity to offer more new paediatric appointments and address waiting list demands.
• Significant return on investment, with the service yielding 2.2 times its cost.
• Increased virtual care: as the pharmacy clinic operates predominately virtually, this improves accessibility and flexibility for patients and caregivers, reducing geographical barriers and increasing convenience in accessing specialised care.
• Additional skill set of Pharmacists complementing multidisciplinary team, improving paediatricians’ understanding of medications.
• Pharmacists broaden their scope of practice, functioning seamlessly within the interdisciplinary team.

Background

The CDS at the Gold Coast HHS pioneered pharmacist integration within the service four years ago, marking an industry first. This innovative service delivery model has resulted in development of clear guidelines around the role and scope of the pharmacist within paediatric disability care and showcased tangible benefits in quality of patient care and clinic efficiencies.

Over the past 24 months, the Paediatric Development Clinic has faced unprecedented demand with a 175% increase in new referrals. Despite the implementation of various improvement priorities, this demand has exceeded allocated funding resources.

Discussion

The increased efficiency is evident in reduced waiting times, increased occasions of service per patient, improved quality of care and a significant return on investment:

Graph 1: Demonstrated uptake of Pharmacy Clinic

Graph 2: Average number of Occasions of Service per patient per year

• demonstrated uptake of patients to service, with at least 27% of paediatric patients in shared-care arrangement with pharmacy (Graph 1)
• a reduction in paediatric appointments required for each patient (Graph 2)
• through the combination of paediatrician-pharmacist shared-care, an increased number of review appointments per patient
• ability to provide clinical review in a more appropriate time frame i.e. pharmacy one - two months vs paediatrician eight months
• significant return on investment, with the service yielding at least 2.2 times its cost
• increased utility of virtual care for medication reviews, with the service providing 96% of appointments virtually in 2023
• verbal feedback from families about benefit of service, however yet have received formal qualitative data
• average failure to attend rate of 11% (within industry norms of 10-15%)
• the addition of the 0.4 FTE temporary pharmacy support over the last 12 months has contributed to paediatricians being able to see a 28% increase in their new case load
• a 10% decrease in patient wait time for a new appointment
• upskilling of paediatricians’ in knowledge of medications
• increased pharmacy scope of practice, functioning as an inter-disciplinary team member
• multiple enquiries across Australia from other services seeking guidance in setting up similar models of care, including across General Paediatric settings for other health conditions.

Lessons learnt

Lessons learnt include:

• Pharmacists can play a pivotal role in providing an alternative to paediatrician’s performing routine medication follow-up appointments.
• The team of pharmacists does need to be relatively small (currently stable staffing of 6-8) so that they can be adequately trained up on some of the non-pharmaceutical interventions provided to our families.
• Adequate paediatric supervision time needs to be factored in to provide case discussion, write any urgent referrals required by families and write scripts.
• Patients have embraced virtual care, however, to ensure safety with medication follow-up, this does rely on the patients to have growth and blood pressure measurements completed at their local community pharmacy. This has required training of families and some email follow-up after clinic to obtain these results, as well as pro-active strategies (such as adding this information into reminder text messages about upcoming appointments).