Addiction clients of Nelson’s Victory Square Pharmacy now have a better quality of life thanks to a project to improve their physical health through access to appropriate diagnosis and treatment of their other health conditions, enhanced self-awareness and encouraging self-reliance and independence.
People who take methadone, an opioid substitution treatment (OST), are an ageing population and die on average 25 years earlier than the rest of the population.
Project lead and Victory Square Pharmacy owner, Dee Magee, says OST clients often have other mental and physical health issues, but find it difficult to access health providers to either diagnose or help with management of their conditions.
She says barriers to accessing health care are different for each client. ‘Some don’t have a good relationship with their GP, or have debt there. Others feel judged, with one commenting, “once they know you’re on methadone, everything changes”.’
Methadone can affect heart rhythm, as can other drugs which may be prescribed. Those taking it should therefore have regular electrocardiograms (ECGs).
‘We see our OST clients every day and we see what else their GP, specialist or hospital emergency department prescribes. Our job is to watch for potential drug interactions and side effects, so we felt we were well placed to support these clients with their health care management across multiple providers.’
The project was one of nine from primary care provider teams from around the country selected for the Health Quality & Safety Commission’s 2019 Whakakotahi quality improvement programme.
Primary care teams were supported by the Commission to implement quality improvement projects in an area of patient care they wanted to improve that was important to their patients and community, and to them as providers.
All the projects supported the Commission’s three primary care strategic priority areas of equity, integration and consumer engagement. Equity was given greater importance in the Whakakotahi 2019 selection criteria.
A member of each project team was also offered a position on the primary care quality improvement facilitator course delivered by Ko Awatea and the Commission's primary care and capability building programmes.
All 30 of the pharmacy’s OST clients agreed to take part in the project. They were able to choose their level of participation, which included a medication review with a clinical pharmacist and being supported to attend district health board-funded appointments with their GP.
Some clients requested a pharmacist accompany them to appointments as a clinical advocate and some met with their health provider in the pharmacy’s consultation rooms.
Mrs Magee says having a client with experience of OST as an integral member of the project team from the beginning was a major benefit.
‘As health professionals, we sometimes place an educated lens on what we think the solution to a particular problem could be or how it should be approached. Having an OST client as our consumer representative who was open, engaged and willing to share her experiences, as well as give critical feedback, allowed us to focus on areas that would most benefit clients in a format they would understand.’
Monthly questionnaires, co-designed by the clients, asked how confident they were talking to their prescriber about their health care and how much control they felt they had over their health care.
Mrs Magee says the information gathered was used to highlight gaps in the system and generate ideas for improvement. ‘Importantly, clients were happy to share their stories with various groups as a means of effecting change in the system.’
At the end of the project, reported ECGs for the OST clients had increased from 27 to 45 percent. All clients also reported increased confidence in talking to their prescriber and having more control over their health care.
‘We also had a hospital pharmacist on the team, which was valuable for improving networking and we’re continuing to advocate to close the gaps we know are still there.
‘For example, it can be difficult finding a vein in some OST clients, and we’re working towards improving access to ultrasound-guided blood-taking for these patients requiring regular blood tests.
‘We met with addiction services and cardiologists to discuss cardiology recommendations for clients prescribed methadone and are in the process of formalising guidelines. ECGs are now recommended as part of baseline screening.’
She says sharing the project’s ‘clinical pearls’ of knowledge among health professionals has embedded changes into practice.
‘Our knowledge of the quality improvement tools has also increased and we learnt quality improvement often involves challenging the culture of health care.’