New Models of Chemotherapy Delivery

in a Rural Setting

Sandra Melville BOPA October 2007

The “Oban” Model

• Based at Lorn & Island Hospital in Oban

• Visiting oncologist from Beatson Oncology Centre

• Patients able to receive treatment locally

• Cut down need/frequency of travel

• 200 mile round trip

Where’s Oban?

Why provide a service there?

• Scottish Government Publication:

Delivering for Health: “Service models that are effective in urban areas may be unsuitable in such locations.”

• Cancer redesign meetings - “except Oban”

• Long journeys to Glasgow – emesis!

Why provide a service in Oban?

• Patient demand (they don’t like

being sick!)• “Each Rural General Hospital should

examine what level of elective service it can safely support” (Delivering for Health)

• Provide a safe service as locally as possible (Not vice versa!)

But….

•Oncologist visits fortnightly

•Most chemo given weekly or

3weekly

•Noticed this wasn’t handy!

• Pharmacist Prescribing

So how does it work?

Nurse/pharmacist led serviceSupported by visiting oncologist and 24/7

consultant physician coverPharmacist prescribesPatients get treatment locallyCare often shared with Beatson Oncology

Centre, Glasgow

What are the threats/challenges ?

Small teams – sustainability

Communication with visiting oncologist

Geography!

Rural Setting

Gateway to the Isles

Serves large rural population

17 % of population live on islands

Coastline of Argyll is longer than that of France

What this means for patients…

26 inhabited islands:

Limited access to health servicesSome have no resident GP

Only one has a community pharmacy!

Re-admission to hospital can be challenging

Especially in the winter……

How did Supplementary Pharmacist Prescribing Improve Patient Care?

• Clinical Management Plans – increased contact with pharmacist

• Enhanced continuity of care• Improved access to advice, medicines

information and supplies • Speedier discharge from hospital, reduced

number of overnight stays – limited ferry services

Optimising Care

Good communication with oncologist

Increased contact between prescriber & patient

Doses tailored to suit individual needs

Close working relationship with chemotherapy nurse specialists

Toxicities minimised – particularly important for patients travelling back to remote islands.

Services in other Rural Areas•Orkney – population 21,000, 16 inhabited islands

•Peripheral cancer unit co-ordinated from Aberdeen

•Nurse/pharmacist led Capecitabine clinic

•4/5 hour car journey from Aberdeen, + 1 hour ferry crossing

•OR 1 hour flight!

Thank You