The pharmacist-led accelerated transfer of patients to shared care for the monitoring and prescribing of immunomodulatory therapy during covid-19

ABSTRACT

Introduction and Objectives Shared care allows for optimal local management of patients with support and guidance from the specialist secondary/tertiary care multidisciplinary teams. Implementing shared care for patients managed with immunomodulatory medicines by an interstitial lung disease (ILD) service was accelerated during the COVID-19 pandemic to minimise the risks associated with travelling to a specialist clinic for consultation, monitoring and supply of medication. Methods Patients were deemed eligible for shared care if they had been prescribed a stable dose of immunomodulatory medication included in the shared care guideline for 3 months. The specialist pharmacist(s) sought permission from the patient and requests were sent to general practitioners (GPS) with a primary care decision form to be returned within 2 weeks. Reminders were sent for shared care responses not received within this timeframe. All patients that had shared care accepted were transferred to GP for the monitoring and supply of immunomodulatory therapy. All other patients were monitored remotely and had medications supplied via specialist centre. Results Of 352 eligible patients, 350 agreed to requesting shared care with primary care providers for immunomodulatory medication(s). Acceptance of shared care was received for 226 patients (65%) and refusal for 17 patients (5%). The barriers to transferring care included no response from GP (104 patients, 30%), hospital only status of medicine under local Clinical Commissioning Group (CCG), patient deemed complex by GP and/or poor adherence. Conclusions This study demonstrates how different healthcare providers worked together effectively to deliver high standards of integrated care, tailored to the individual needs of patients with ILD, during the COVID-19 pandemic. Uptake of shared care could be improved by direct communication pathways with GPS, increased education in the management of immunomodulatory medicine(s) for primary care providers and review of CCG categorisation of medicines included in the shared care agreement. Shared care may improve accessibility to medicines and reduce environmental impact. We suggest further studies to assess monitoring in primary care, patient feedback, impact on specialist clinic capacity and financial implications.