Developing a Liaison Role for Pharmacists in a Family Medicine Clinic

Abstract

Objective: To develop a pharmacist liaison service in a family medicine teaching clinic in order to optimize and facilitate community pharmacists' interventions. Target groups: Community pharmacists involved in the care of patients registered at the family medicine clinic (FMC) of Cité de la Santé de Laval and clinical pharmacists working at this clinic. Activities: The FMC is a medical teaching clinic located in a general care hospital. The FMC operates as a multidisciplinary group of GPs, nurses and pharmacists providing care to enlisted patients. Due to their clinical experience, proximity to the medical team and direct access to FMC patients' charts, FMC pharmacists (FMC-PH) are in a key position to support community pharmacists (COM-PH) in order to optimize the quality of pharmaceutical care dispensed to their common patients. The liaison pharmacist service was created within a larger study of COM-PH interventions and their impact on medication when receiving a doctor request for medication profile analysis and a standard prescription or a prescription enriched with additional clinical information. Forty-nine COM-PH interested in participating in the larger study attended one of 3 workshops offered by pharmacy residents, FMC-PH and a physician. Information on the clinic and the new service of liaison as well as case studies on medication adjustment and laboratory monitoring were presented and discussed. A decision aid tool was also provided to participants. A FMC-PH is available from Monday to Friday (9 a.m. to 4 p.m.) to answer questions by telephone from COM-PH directly related to FMC's patients' care and links with the medical team when necessary. Liaison tasks were added to other clinical duties and responsibilities of the FMC-PH. Communications with COM-PH were documented by FMC-PH between November 2007 and April 2008. Deliverables: Fifty-eight communications involving 27 COM-PH and 49 patients have been documented. Among 78 drug-related issues discussed with FMC-PH, the most frequent were obtaining results or suggesting laboratory monitoring (35%), discordance between pharmacy medication chart and FMC chart (18%), dose too high (8%), additional medication needed (8%), dose too low (5%) and inappropriate medication. Among the 93 actions taken by FMC-PH in response to contact with COM-PH, the most frequent were transferring additional laboratory results (29%) or additional information related to treatment (22%) to COM-PH, transferring new information and recommendations to the medical team via case discussion with treating physician and/or writing a note in the FMC patient's chart (22%), revising medication history (14%) and correcting patient's medication profile in the FMC chart (11%). The mean time per action was 9.5 ± 8.9 minutes. Conclusion: The liaison pharmacist service was used regularly by the community pharmacists and was easily integrated in the FMC-pharmacists' tasks. Community pharmacists' calls resulted in additional information or correction of available information to the FMC team in 33% of cases. Community pharmacists were very interested in obtaining laboratory results and additional clinical information to optimize their patient follow-up. This model of liaison succeeded in increasing collaboration and improving flow of information between pharmacists.