Nurses are open to community pharmacists stepping up their involvement in primary healthcare as long as there are robust processes, said College of Primary Health Care Nurses chair Rosemary Minto.
The government is considering rolling out a pharmacist lead model for managing warfarin treatment after a successful trial run by Health Workforce New Zealand.
The trial involved pharmacists conducting finger-prick blood tests of patients in 15 community pharmacies across the country, advising patients on their medication management and, in collaboration with their general practice, modifying the warfarin dose when required.
Minto, a primary health nurse practitioner, said warfarin management is carried out in a variety of ways in general practice. Sometimes GPs are directly involved with nurses co-coordinating, while in some practices nurses use a form of standing orders. She also understood that in the MidCentral region it was carried out successfully by a community health laboratory.
An Auckland University evaluation of the pharmacy trial said anticoagulant control blood results improved “significantly” for patients on the six-month trial. Patients also reported they were satisfied, as fewer general practice and laboratory were involved.
Minto said the NZNO college supported the concept of a multidisciplinary team approach to providing primary health services, and recommended that the process should be robust to ensure fragmentation of the service did not “further complicate the patient experience and provide potential drug errors”.
She said whoever was carrying out the warfarin management had to have all the information they needed; they had to be aware of the patient’s health literacy (their ability to manage the health advice provided); and had to have satisfactory communication with the patient’s GP or NP about their warfarin dose and any changes of dosage or medication.
Pharmacy Society president Elizabeth Plant said the project confirmed that pharmacists could take on a greater role in medicines management working within an integrated team.
“The pharmacist can spend time with the patient discussing their treatment at a time that’s convenient, which helps with compliance as well as freeing up nurses and GPs to do what only they can do.”
