Quality improvement project improves medicines access for remote patients

12 November 2020

Originally published by the Health Quality & Safety Commission New Zealand and has been edited with permission 

Patients in remote settlements of eastern Bay of Plenty now have better access to timely and accurate medicines, thanks to a quality improvement project undertaken by the Te Whānau-ā-Apanui Community Health Centre in Te Kaha.

The health centre provides general practitioner and nurse-led clinics for patients in a 150 km section of winding coastline from Hawai to Pōtaka where the nearest pharmacy is an hour’s drive away in Ōpōtiki. The centre is one of only three in the country with the status of ‘a special area’. It operates without a primary health organisation, is funded by Bay of Plenty District Health Board and services are free to all residents within the rohe (area) boundaries.

Around 1,500 predominantly Māori patients are registered but double that number of patients can be seen casually over the summer holiday period.

About the project

The project aim was to have 90 percent of Te Kaha patients receive their non-urgent medication within 48 hours of it being prescribed, in keeping with expectations for prescriptions generated in Ōpōtiki.

Project team supervisor and Fellow of the College, Dr Emily Gill, says it wasn’t until doing the process mapping that the complicated process of getting the prescription to the pharmacy was fully understood.

“So many people were involved. It was no wonder things were falling through the cracks. 

“Usually, a prescription is taken to the pharmacy by the patient, either at the time of the appointment, or they’re phoned and asked to pick it up and take it to the pharmacy. This meant everything was in the hands of the patient and it’s simply not practical for a patient to drive an hour or more to drop off their prescription in Ōpōtiki.

“Doctors were all doing slightly different things with prescriptions, thinking we were being helpful, but it meant prescriptions were going missing,” says Dr Gill.

“For example, I work remotely and assumed, when I pressed print on my computer, that the prescription was printing in the Te Kaha clinic for reception to then fax it to the pharmacy. But I couldn’t verify that. I was also writing prescriptions late in the evening and putting them in an envelope for a courier to take to the pharmacy, without realising it may not be opened for another couple of days,” she says.

As the project evolved, the health centre’s receptionist, Ripeka Te Haara, in discussion with project lead, Kiritahanga Savage, created a filing system to record prescriptions faxed to the pharmacy and a form to help the pharmacy reconcile prescriptions received with medicine delivery.

“Ripeka would also phone the pharmacy to verify every prescription had been received. This was key to achieving improvement and now all prescriptions go through this process,” says Dr Gill.

Focusing on making the biggest improvements

The project team decided to focus its improvement measurement on prescriptions generated for patients seen at the Waihau Bay clinic – a further hour away from Te Kaha and therefore two hours from the pharmacy at Ōpōtiki. Dr Gill says they had the most logistical challenges in accessing their medicines because the GP clinic only operates on a Tuesday.

After sorting out the process, every time a prescription is generated, it now gets funnelled through one person, which improved numbers very quickly.

“Patients were part of the measurement process because we phoned them a couple of days after the prescriptions had been written to check they had received their medicine.”

Dr Gill says the project was important, tailored to the community’s needs and has made a real difference. “It was a lot of work, though, and the time needed isn’t built into general practice. It also put more pressure on the pharmacy’s prescription logistics management.”

However, she says staff who were sceptical about the process because of the time involved came away seeing value in it and are now some of the most supportive quality improvement advocates.