Clinical Assessment and Care Coordination

Service types: Home support, Home visits, Needs assessment, Community nursing, Self management, Medication administration.

In collaboration with the GP practice, the team will assist with clinical assessment and care coordination of complex patients in their home, outreach visits or at RAPHS. This may include:

• Written care plans
• Facilitation of patient's care, compliance/adherence
• Pharmacist clinics within your GP practice
• Medication reviews and/or education
• Optimisation of patient’s medicines
• Medicines reconciliation/support post hospital discharge
• Clinical audits to identify patients in whom pharmacotherapy can be improved for example patients on ‘triple whammy’