Research Areas

Advanced practice scope for pharmacists embedded in @home services in regional and rural settings

 Aim:

To improve medication management and contribute to better health outcomes of patients admitted to @home services, by increasing the scope of practice for pharmacists in @home services.

To utilise advanced practitioner roles for pharmacists in @home services to prevent duplication of services, save time and visit costs.

Objectives:

• Demonstrate the effectiveness and sustainability of the advanced pharmacist @home program, which will support its integration into usual care delivery within the current hospital @home model.
• Develop an advanced pharmacist @home service incorporating: Partnered Pharmacist Medication Charting (PPMC), vital sign monitoring, INR monitoring and blood glucose monitoring, as well as metabolic monitoring within mental health HITH.
• Developing a credentialing package for the advanced pharmacist @home service.
• Initiate metabolic monitoring in mental health HITH clients.
• @home pharmacists to provide - patient education, proactive medication management and clinical intervention.
• @home pharmacists to minimise frequency of health practitioner visits/occasions of service (OOS).
• Provide a @home pharmacist resource for other regional centres.

Project scope:

• Patients admitted to @home programs within Barwon Health – including GEM @home, Rehab @home and mental health HITH.
• Patients admitted to Barwon Health’s GEM @home service – which supports older people (generally 65 years of age and over) with multiple and complex care needs to be assessed, treated and managed at home. The service provides time-limited integrated multidisciplinary care to improve functional capacity and address multidimensional needs. GAH provides consumers with an option to receive care in their own home environment where inpatient management would otherwise have been required.
• Patients admitted to Barwon Health’s rehabilitation @home service – which supports people who are recovering from an injury, illness, surgical or medical procedure and addresses rehabilitation goals that are best met in your home. The service delivers intensive therapy to patients in their own homes, through multiple daily visits from an integrated multidisciplinary healthcare team.
• Patients admitted to Barwon Health’s mental health HITH – which is an alternative option to hospital admission for those people experiencing an acute episode of mental illness. The service provides specialist mental health support and treatment through a multidisciplinary team in the patient’s home environment, alongside their family and carers.

Following local development, the program will be tailored/extended regionally where limited @home pharmacist support exists, within a Barwon South West site and Grampians Health.

Funding source: Department of Health Victoria

VANISH Trial into treatment for smoking cessation among hospitalised smokers

Background: Varenicline is the most effective sole pharmacotherapy for smoking cessation. If used in combination with nicotine replacement therapy (NRT) cessation rates may be further improved.   

Objectives: To determine if hospitalized smokers treated with varenicline and NRT lozenges achieve higher prolonged smoking abstinence rates compared to those treated with varenicline alone.

Methods: A double-blind, placebo-controlled trial was conducted in adult inpatients with a history of smoking ≥10 cigarettes/day. 12-week varenicline was initiated during hospitalization at standard doses in all participants. Participants were randomized to additionally use NRT (2-mg) or placebo lozenges if there was an urge to smoke. Behavioural support (Quitline) was offered to all participants.

Results: We randomized 320 participants (mean±SD age 52.5±12.1 years, 57.2% male). Biochemically verified abstinence and self-reported abstinence favoured combination therapy: 1) self-reported 6-months prolonged abstinence (OR=1.49 [95%CI 0.93-2.37]); 2) 7-day point prevalence abstinence at 6-months (OR=1.70 [95%CI 1.04-2.78]); 3) biochemically verified 12-months prolonged abstinence (OR=2.27 [95%CI 0.84-6.14]); 4) self-reported 12-months prolonged abstinence (OR=1.81 [95%CI 1.07-3.06]); and 5) 7-day point prevalence abstinence at 12-months (OR=1.79 [95%CI 1.06-3.01]).

Medicine-related adverse events at 6 months were similar in the two groups – intervention 102 (74.5%) vs control 86 (68.3%).

Conclusions: The combination of varenicline and NRT lozenges improved abstinence following hospitalization, without compromising safety. 

Australian Clinical Trials Register ID ACTRN12618001792213

Submitted for publication

Establishment and evaluation of a perioperative medicines management service at regional hospital sites in Western Victoria

Patients undergoing surgery require an accurate medication history to identify high-risk medicines, prevent medication error and safely plan for care. A medication history is established from various sources, including information obtained from patients, carers, general practitioners, community pharmacies, previous admissions and nursing homes.

Australian and international studies demonstrate pharmacists working within clinics seeing patients before surgery improves the accuracy of medication histories and subsequently the hospital medication orders compared to standard care where doctors complete the process. Our own research has shown a significant reduction in medication errors when a pharmacist not only completes the medication history, but also charts hospital medications in agreement with the doctor. We have a credentialing program for pharmacists undertaking charting roles in general medicine and oncology. We have also provided credentialing for regional pharmacists.

Aim:

To implement and evaluate a perioperative pharmacy services model of care within a wider regional perioperative management unit framework.

Translation, evaluation and dissemination objectives:

• Co-design a model of ideal perioperative medicines management based, with consumer experiences and a literature search informing a facilitated consensus model developed by, and incorporating preferences and needs of consumers and clinical stakeholders.
• Establish a multi-disciplinary governance committee. Regional representation sought.
• Develop and trial the model under a plan-do-act cycle (integrating quantitative evaluation of baseline and post-implementation key performance indicators informed by PPMC – measuring impact on quality of care)
• Develop educational materials and credential perioperative pharmacists within Barwon Health.
• Develop clinical procedures for the perioperative pharmacy service
• Evaluate clinical significance of interventions made by pharmacist within developed model of care and compare to literature
• Interviews with clinicians and consumers for qualitative evaluation establishing model feasibility, acceptability and sustainability; framework analysis using Consolidated Framework for Implementation Research to understand implementation.
• Monitor medicine related interventions
• Translate developed materials into a toolkit for use by other regional centres.
• Conduct applicability of funding mechanisms assessment e.g. Tier 2 NWAU funding