Teaching cross-sector medicines optimisation to primary care pharmacists from a patient’s perspective

Medicines optimisation is about achieving the best possible outcomes for patients through the safe and effective use of medicines^[1]
. Working in general practice requires pharmacists to develop a detailed understanding of the complex issues involved with medicines optimisation between different healthcare sectors, while ensuring a patient-centred approach.

As part of teaching and learning, direct contact with patients has been shown to support the development of professional attitudes, empathy and clinical reasoning skills^[2]
.

In September 2018, the School of Pharmacy and Medical Sciences at the University of Bradford launched a new postgraduate ‘advanced therapeutics in primary care practice’ module. Students on the programme are pharmacists working in primary care settings with varying post-qualification experience. This module forms part of the university’s primary care clinical pharmacy programme.

Innovative teaching methods for this new module involved working with a patient with long-term conditions and extensive experience of using NHS services, including transfer of care across sectors of practice. Students took part in a clinical teaching session that used the Cambridge framework ‘Questioning–informing’ domain^[2]
.

The MPharm programme at the University of Bradford has utilised patient involvement for undergraduate teaching for several years; however, this was the first time that postgraduate pharmacy teaching and learning in this programme had been supported by a patient with such extensive experience of the NHS. Prior to starting the programme, the students had limited time in practice to gain an in-depth insight into the patients’ perspective of their care.

The aim of the teaching was to encourage pharmacists working in general practice to explore medicines optimisation issues across healthcare sectors from a patient’s perspective. The teaching comprised of a two-hour workshop at the University of Bradford on one of the module study days, facilitated by the module lead. The patient described personal experiences of medicines optimisation between primary and secondary care. The patient journey was split into several stages, based on personal timescales and experiences. Medicines optimisation issues at each of the stages were explored with students, with the opportunity to discuss the main themes that had proven to be barriers to patient-centred medicines optimisation across the various healthcare settings.

The format of the workshop enabled tailored discussions within the four main areas of the Cambridge framework ‘Questioning–informing’ domain model^[
2]
. These four areas are who, how, what and where:

• The ‘who’ comprised a patient with extensive knowledge of their medical condition, treatments and interactions with the NHS;
• The ‘how’ was a tutor-facilitated, time-limited, focused, learning opportunity with a patient. This allowed for questioning and discussions with the patient and enabled a holistic learning experience;
• The ‘what’ produced a high-impact teaching and learning experience that had a focus on medicines optimisation and allowed exploration of complex themes;
• The ‘where’ was an educational setting, rather than a healthcare setting.

The following medicines optimisation issues were explored:

• Enabling the continuity of the supply of ‘red medicines’ (i.e. hospital-only lines) once the patient was at home;
• Ensuring that medicines were reviewed regularly, monitored and started/stopped appropriately — taking polypharmacy into consideration;
• Synchronisation of complex medicine supply in primary care and communication barriers when considering medicine changes between secondary and primary care, and vice versa.

Problems the patient encountered were discussed, and students explored the possible options and strategies with them. In addition to their previous work-related experiences of cross-sector medicines optimisation, pharmacists were able to reflect on the experiences from the patient. Discussions with the patient and having peers in the workshop allowed the opportunity for students to identify potential solutions for future practice.

The teaching enabled the opportunity for targeted discussions within the four main areas of the Cambridge framework ‘Questioning–informing’ domain model for a patient to support teaching for healthcare professionals. This successful model is placed within Level 2 (limited involvement) of the ‘Ladder of involvement’ framework for service-user involvement in teaching and learning^[3]
. This is where patients/case studies are used for problem-based learning and service users are invited to tell their story.

Quantitative assessment of student feedback on study-day evaluation forms scored highly, with a mean score of six (scored between one and six, where six was the highest). Qualitative feedback showed that students had engaged with the interactive nature of the workshop, with one student saying “the expert patient was the most useful part of the module”.

The workshop was repeated in October 2019 for the next cohort of students, with equally positive feedback. From January 2020, the primary care, secondary care and community clinical pharmacy programmes at the university are being combined into one multi-sector programme. For future work, the programme team is looking to further develop a partnership with patients in teaching and learning to achieve Level 3 (growing involvement) of the ‘Ladder of involvement’ framework. To achieve this, involvement sessions with service users and carers are planned in advance, where there will be mutually agreed learning outcomes, evaluations and expectations. Furthermore, staff and students will be able to show evidence that they are reaching out into communities and are continually developing networks and relationships with service users, carers and relevant organisations.

Sandra Martin, lecturer in pharmacy practice, University of Bradford

Julie Sowter, senior lecturer in pharmacy practice, University of Bradford

Duncan Petty, research practitioner in primary care pharmacy, University of Bradford

Gemma Quinn, lead for postgraduate taught clinical programmes, University of Bradford