In the last of a series of 3 articles about NHS Tayside Lead Pharmacist, Yousaf Ahmad outlines the detail of the teach and treat model in chronic pain
IN Tayside, the teach and treat model is being used to help upskill inexperienced and interested pharmacist professionals working in primary care in the area of specialised pain management. The key aims of this project are to:
- Develop community-based pharmacist led pain clinics for patients with chronic pain, many of whom will have polypharmacy issues.
- Develop and validate a competency-based framework, setting out clear education and training settings expected by those colleagues involved, and to support the inter-professional training and integrated service delivery for improved patient care in a priority clinical group within NHS Scotland.
To date this has involved a number of key work streams have been achieved:
- The development of a competency training framework – this is a framework developed by experts in the field of pain management and focuses on looking at what skills are required by healthcare professionals in the delivery of specialised pain management.Key themes attributed here are background knowledge, self-management techniques, pharmacological interventions, and health behaviour change strategies. This framework was validated using an expert panel group and has become one of the first pharmacist training frameworks within a specialised clinical area specifically designed for pharmacists.
- Identification of pharmacists in primary care – to date a total of eight pharmacists has been identified to undertake the teach and treat model of delivery. These early adopters will be the first cohort of pharmacists working through the competency framework and will be mentored by medical consultants within this specialist pain service. This is the first step taken by any health board to allow the integration of pharmacist colleagues in primary care into this secondary care service
- Training Day – Using the developed competency framework as the foundation, a programmed training event has successfully been undertaken. Primary care pharmacists attended secondary care facilities and took part in education sessions provided by pharmacists and other healthcare colleagues working within an specialised area of practice. This integrated learning platform proved extremely beneficial at building new learning for colleagues involved, but also created the networks and links needed to integrate primary care pharmacists with their secondary care counterparts.
With a strong focus on evaluating outcomes, I believe a constant search to create an evidence base for pharmacists working in clinical areas is of paramount importance. Thus throughout this project, I have set a number of outcomes to evaluate the process and create a robust argument for pharmacists working in the field of pain management. Some of the outcomes I have recorded include:
- Numbers of patients seen.
- Patient and clinician feedback questionnaire: CARE tool.
- Medicine use (pre- and post-pharmacist intervention) – monitored using their CHI numbers and the prescribing systems, including changes relating to medicines stopped, started, doses reduced and switches.
- Changing number of inactive pharmacist prescriber to active pharmacist prescribers.
- Validated pain outcomes to ascertain any change in the pain management of patients that are seen in a pharmacist clinic.
Empowerment of pharmacists within this model
I believe this creation of a validated competency training framework specific for a clinical condition, is essential at giving pharmacists on the frontline the right skills and knowledge needed to care for patients effectively. Ensuring a competent workforce allows individuals to gain the confidence needed to make those quality driven interventions that actually positively impact on patient care.
For too long, pharmacists and their teams have not been able to really get to grips within making those clinical decisions pertinent to the patients they see on a regular basis. I believe the use of ‘refer you to your GP’ has been used too prematurely and part of the reason behind this, is that pharmacists do not feel empowered to give their patients the advice which they know could have a real benefit. In addition, this is perhaps a lack of clear governance and support for frontline staff by those that regulate their work locally and nationally.
Part of NHS Tayside’s teach and treat model, is not only train and empower pharmacists within a specific clinical condition, but it is also to give them the mentor and peer support to enable them to make the contribution they feel that’s most appropriate to their patients. It is only when this is achieved, that pharmacist interventions will truly be seen.
Yousaf Ahmad is Lead Pharmacist at NHS Tayside
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Evidence based research on pharmacist interventions in pain management
 Bruhn H, Bond CM, Elliott AM et al. Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial. BMJ Open 2013;3 (An exploratory randomised controlled trial- PIPPC Study)
 McDermott ME, Smith BH, Elliott AM et al. The use of medication for chronic pain in primary care, and the potential for intervention by a practice-based pharmacist. Family Practice 2006; 23: 46–52
 UCL- LESS Pain Toolkit; The results of a community pharmacy pilot pain service evaluation (The LESS PAIN toolkit was designed to facilitate well informed semi-structured discussions between community pharmacists and service users with pain related problems
(N.B As a profession we need to start creating more of this evidence based relating to Pharmacist interventions in clinical conditions, so that we can prove the benefits for a pharmacist at managing patient’s clinical care)