Aim To explore the views and experiences of healthcare professionals in primary care around the supply of specialist medication after a child is discharged from a specialist paediatric centre and suggest ways to improve it.
Method A qualitative study conducted with semi-structured interview via telephone was carried out to explore the views of primary pharmaceutical advisors on the supply of specialist medicine in children. Participants were identified by reviewing outpatient prescriptions from 19 November 2018 to 30 November 2018. Telephone interviews were recorded on interview forms, as the form of data. Framework analysis was used to analyse the data.
Results A total of 109 outpatient prescriptions with 56 Clinical Commissioning Groups (CCGs) were identified. 8 CCG pharmaceutical advisors were recruited. Four key themes were identified.
Theme 1: In order to overcome issues around the supply of specialist medicines, it is important to understand different supplying considerations in primary care. Factors including patient clinical status, GP’s expertise and confidence in prescribing and shared care agreement.
Theme 2: Actions that are untaken by primary care to solve supplying issues include drug alternatives, direct communication between clinicians and the clinical input of pharmacists.
Theme 3: Views on current shared care arrangements were generally negative. For example, participant 2 expressed: ‘Good principle… but they are too wordy, they are 10 pages long’.
Theme 4: Views on improvement in continual medicines supply included participants explaining the lack of understanding between GP and Specialist. Participant 1 commented, ‘Specialist has to understand we lack the expertise to prescribe the drug. It is not just about money…’.
Conclusion Currently there is a lack of an integrated system in medicines supply at the tertiary to secondary/primary care interface. In order to deliver continuity of patient care, there is a need for different healthcare professionals to break down preconceptions and understand the pathway and policy involved in different care setting. A shared care should involve patient and carers, GP and the hospital consultant when making decision on the child’s health. Moreover, pharmacists in different settings have an active role in medicine optimisation and it is important to value their opinions to improve the continuation of specialist medicines supply.
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