Collaborative effort within a multidisciplinary heart failure team

Abstract

Background Pharmacists work directly with other healthcare professionals and with patients to assess, monitor and modify their pharmacotherapy. Pharmaceutical care is not just about expanding the pharmacist’s role but about a system that pharmacists help to establish and maintain. Purpose To develop a pharmaceutical contribution within evolving multidisciplinary patient centred models of care leading to continuous improvement in the standard of care provided to patients with chronic heart failure. Material and methods The Medication Assessment Tool for heart failure (MAT-HF) was developed using indicators intended to support monitoring of adherence with processes of care related to medication and disease management to improve health outcomes. Each criterion in the MAT-HF follows a basic algorithmic scoring structure with a qualifying statement and a standard, with 6 different answer categories. The MAT-HF was psychometrically evaluated and implemented in the initial part of the ward round and again after relevant discussion with pharmacist and the multidisciplinary team and the patient. The targeted patient population was selected as per the inclusion criteria. The approach taken was to note down anything in relation to the MAT-HF standard during the primary assessment. Care issues were identified and the relevant changes in treatment and/or patient’s ailments were discussed with the other healthcare professionals directly during the ward round. Thereafter, the MAT-HF was used for re-assessment. Results 312 patients were reviewed; only 50 patients (44–93 years; 58% women) met the inclusion criteria. The average score of the MAT-HF adherence rate within the initial part of the ward round was 69% (CI 65%, 74%) and the MAT-HF adherence rate average score implemented subsequent to the pharmacist consultations with the team was 90% (CI 89%, 92%). There were justified incidences of non-adherences to the tool mainly due to treatment of comorbidities, such as arthritis and malignancy. Conclusion The pharmacist has a crucial role in either delivering the actual tool or monitoring the improvement in quality of care for both ambulatory and hospitalised patients. The collaborative therapeutic management had a positive outcome on the treatment of the patient. Inappropriate prescribing, dispensing and omissions would be avoided by the use of such explicit assessments.