S. Ahmad^1
1Rheumatology Department, Lever Chambers Centre of Health, Bolton, United Kingdom

Background: A pharmacist wholly committed to working within a rheumatology clinic, working alongside other health professionals (consultants, nurses, physiotherapists, etc), is still a novel approach in the UK.

Bolton rheumatology service covering a population of 300,000 employed a pharmacist 3 years ago to uniquely contribute to the department. The pharmacist’s specialised knowledge and experience on medication has been used to enhance the care to Bolton rheumatology patients.
Objectives: Analyse types of interventions made by the rheumatology pharmacist
Assess impact pharmacist interventions have had on patients and on the rheumatology department
Outline the advantages of having a pharmacist working closely with the other health professionals within the rheumatology department
Look at further areas where the rheumatology pharmacist could bring about benefits to both patients and the department
Methods: Patient medical records were used to elicit relevant information on pharmacist interventions over a 6 month period
Records were accessed in order to analyse all the drug queries requested from within the department that were answered by the pharmacist
Data was compiled using records to show the clinical patient focussed activities of the pharmacist over a 6 month period
Results: 111 patients were referred to the pharmacist from health professionals over a 6 month period, for either specialised medication reviews or request for medicines information. The following summarises the interventions made by the pharmacist:
32% of pharmacist interventions were for medicines information advice provided to health professionals and consultants
13% of medication reviews related to specialised advice on pain relief
6% of interventions related to inappropriate medication being stopped
5% involved new treatment being commenced/recommended
5% of activity involved the pharmacist acting as an interpreter
4% of interventions involved inappropriate methotrexate compliance/ prescribing being rectified
4% involved medication being stopped due to ADRs (eg. Detrusitol – hot flushes, Depo-provera - fibromyalgia symptoms, Azathioprine – rash, Ibuprofen – rash)
4% of interventions involved giving patients bowel advice
4% of interventions involved the time of medication being changed to improve concordance
4% involved increasing or decreasing the dose of a medication
4% of patients were provided with medication memory charts
3% of patients were given advice on the correct use of inhalers
3% of interventions were not drug related (eg, heat therapy, exercise, acupuncture)
2% of interventions involved the patients being provided with specific written information on medication
2% of patients were assisted in withdrawal from opiod analgesics
2% of interventions involved the pharmacist using her supplementary prescribing qualification
1% of patients had a change made to their drug formulation
1% of patients were provided with metered dose systems (MDS)

Conclusion: This piece of work shows that because a pharmacist is focussed on medication issues, problems related to medicines are readily picked up which may ordinarily be missed. All interventions made by the pharmacist, enhanced the safe, efficient, evidence based and cost-effective use of medicines in patients. Significant time was saved by consultants and other health professionals because the pharmacist was able to provide the medication information they required.