Dr Natalie Soulsby moved to Adelaide 15 years ago where she started working at the Royal Adelaide Hospital (RAH) as a clinical pharmacist. After completing her PhD in 2009 she became an accredited pharmacist and also started working in Clinical Pharmacology. She continues to work in clinical pharmacology at the RAH providing medication reviews in the Multi Disciplinary Ambulatory Services (MACS) clinic. This involves reviewing patients with multiple comorbidities referred to the clinic by medical specialists or GPs. She visits patients at home as part of the MACS service too.
She is also now the National Operations Manager and Associate Clinical Director for Ward Medication Management, one of the largest providers of consultant pharmacy services in Australia. Natalie is dedicated to improving medication management especially in the elderly by helping rationalise the prescribing of medications in this group of individuals and by educating health care professionals in this area.
Natalie is extensively involved in training for pharmacists and pharmacy students, building the clinical knowledge and skills of future practitioners. For over 10 years she has served as author/tutor in the Clinical Pharmacy Seminars conducted by SHPA. She authored a series published in the Australian Pharmacist, providing guidance regarding laboratory investigations.
Rationalising prescribing or “deprescribing” is not a new idea, since we, as pharmacists are always ensuring that the medications being prescribed are for the right person, at the right dose, for the right reason. We know it is important that there is a definite indication for the medication patients are receiving. We do this to help prevent prescribing cascades where one drug is started because of the side effects of another. Deprescribing can be achieved but it has to be done in a methodical manner with support from all parties involved. Each medication must be assessed for eligibility to be discontinued. Drugs then need to be prioritised for order of discontinuation, and most importantly this has to then be implemented and monitored, otherwise the patient could easily end up back to where they started. We also know that poor communication across the primary secondary care interface and between individual specialties in not new. It has been happening for years causing many frequent potentially unnecessary hospital presentations. So, developed the integrated care service we provide. It is specifically for those patients with polypharmacy who require chronic disease management plans. Typically they have multiple co-morbidities requiring complex care. They may see many different specialists. Once they have been referred we are able to rationalise their care, reduce replication of services and co-ordinate a more effective and efficient care pathway. Patients are firstly seen by a nurse, then by a pharmacist and finally by the doctor. The role of the pharmacist is to take a comprehensive medication history, assess their current medications and provide recommendations for continuation, cessation or change in their therapy. At the end of clinic a collaborative plan for their ongoing care is produced. Coming to our clinic allows us to monitor patients more closely to achieve their individualised goals.