Background Shared care guidelines (SCGs) assist healthcare professionals and patients in clinical decision making, allowing the seamless transfer of patient treatment, management, and pharmaceutical care. In Malta, rheumatology patients pick up their chronic medication supply free of charge from a community pharmacy of their choice. It is important that the community pharmacist is aware of the plan by the caring rheumatology team within the public NHS hospital. SCGs enable for improved communication and coordination between primary and secondary settings.
Objectives The aim of the studywas to develop Shared Care Guidelines for rheumatology drugs with an emphasis on the communication between pharmacists within the hospital setting and the pharmacists within a community setting.
Methods A list of rheumatology drugs requiring the development of Shared Care Guidelines (SCG) was compiled. A literature review on the importance, relevance of SCGs and already existing foreign and local SCGs was carried out in order to design the optimal Maltese Rheumatology Shared Care Guideline (MRSCG) template. A draft MRSCG for Infliximab was compiled and evaluated by an expert panel consisting of a consultant rheumatologist, specialised rheumatology nurse, a rheumatology clinical pharmacist and a community pharmacist.
Results An important parameter established during the design of the Shared Care Guidelines was Pharmacist Intervention. The expert panel all agreed that the community pharmacist who is dispensing the rheumatology medications has become part of the extended healthcare team. All members agreed that the role of the rheumatology clinical pharmacist in hospital was well established but the role of the community pharmacist should be strengthened and communication with the community pharmacists should be improved. The first compiled MRSCG on Infliximab consists of 3 main sections. Section A outlines pharmacological background on infliximab, the associated responsibilities of the medical rheumatology team, the rheumatology nurse specialist, the clinical pharmacist, the community pharmacist and the general practitioner. Section B consists of the patient management care. This section incorporates reconstitution guidelines, and documentation of the dose and the pre-infusion monitoring parameters required together with signatures of the respective health care professional carrying out the reconstitution, the monitoring of the patient and administration of the drug on day of infusion. Section C contains referral checklist sent by the medical team to the general practitioner and referral checklist sent by the hospital clinical pharmacist to the community pharmacist at initiation of treatment. All members of the panel agreed that the draft MRSCG for Infliximab was effective in outlining and documenting responsibilities and sharing of patient care between different settings.
Conclusions For a shared care system to be achieved, communication between healthcare professionals in the different health sectors is of vital importance to ensure effective, rational and safe patient management.
Disclosure of Interest None declared