Strengths
This is the first UK programme to systematically describe the post-discharge optimisation of secondary prevention in patients with post-MI LVSD across a large regional health authority. In doing so, it sets a benchmark for comparison for future clinicians and researchers.
The delivery and evaluation of complex interventions is notoriously difficult.31 This quality improvement programme delivered lasting change over Scotland’s largest health authority, utilising multiple different healthcare professionals across primary and secondary care. The collaborative ‘hub’ and ‘spoke’ model used, incorporating both generalists and specialists, has the potential to be replicated by others.
Across Scotland, independent prescribing qualifications are underutilised by pharmacists; this represents an untapped resource.32 The ‘Teach and Treat’ model was implemented as a means of supporting clinical supervision for this group to improve competence and confidence in autonomously managing patients. This type of project, where targeted at measurable public health problems and supported by appropriate governance structures, has the potential to improve clinical outcomes and frontline service delivery. As such, this project is now cited in the Scottish Government strategy for pharmacy as a potential future model of care for the profession.30
The work burden for medical staff, including consultants and GPs, is growing.33 34 The ageing population and increasing multimorbidity is likely to worsen this problem. This model has the scope to spread prescribing and medication optimisation roles, traditionally delivered by medical staff, across other disciplines.