Medicines Management Solutions

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Medicines Management Solutions

• Pam Grant Julia Sparks
• Medicines Management Team
• Bournemouth Poole PCT
• Dudley 5 July 2007

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Medicines Management Team

• Developed from a jointly funded project which
  demonstrated that pharmaceutical care can save
  prescribing costs and prevent emergency hospital
  admissions

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1. Context

• A limited medicines management service commenced
  September 2002
• The current medicines management service
  commenced February 2005
• The team 2 x pharmacists and 4 x half time
  pharmacy technicians
• Based within a multidisciplinary rehabilitation
  team
• Tracks patients across the primary/secondary care
  interface
• We work predominantly in the community visiting
  patients in their homes
• Patient group vulnerable older people with
  complex medical conditions

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Composition of Patient Group

• Average age 83 years
• Males 34
• Females 66
• Average number of medicines 6.7 (range 1-19)
• Living alone or with another person who was
  unable to support them with medicating

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2. Outline of Problem

• Chronic Disease is poorly managed in the
  community by practitioners and patients
• There are no formal ways of educating patients
  about chronic disease
• There are increasing numbers of people with
  chronic long term diseases
• This leads to polypharmacy
• Repeat prescribing systems allow for very little
  control of medicines consumption and costs
• Non-compliance with medical therapy is a known
  cause of hospital admission
• There is no access to pharmaceutical care for the
  housebound
• There is poor communication between community
  medical staff and hospital medical staff

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. Key Measures for Improvement

• Avoidance of hospital admission
• Achieve independent management of medicines
• Improve the patient experience of pharmaceutical
  care

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Team Activities

• Clinical Review (CR)
• Medicines Use Review (MUR)
• Identification of level of lack of concordance
  and compliance
• Risk assessment of likely outcome from
  non-compliance
• Patient/carer education
• Simplification of medication regime
• Dose titration
• Pain management
• Signposting to other health professionals
• Provision of a tailored medicating solution

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Data Collection

• Numbers and types of pharmaceutical intervention
• Numbers and types of chronic disease
• Numbers of medicines used
• Numbers and types of disabilities
• Numbers of admissions to hospital
• Length of stay in hospital
• Savings to prescribing costs

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Analysis and Interpretation

• 2004 analysis showed 18 reduction in emergency
  hospital admissions for patients who had help
  with medicating (n160)
• 2006 analysis showed 25 reduction in emergency
  hospital admission and 44 reduction in length of
  stay (n217)
• 2006 analysis showed 96 patients reviewed by the
  team had no further admissions to hospital
  (n217)

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Change Process

• Present a business case to the Primary Care Trust
  Executive
• Gain the support of GPs
• Recruit additional staff to increase capacity to
  benefit more patients
• Barriers to change were
• lack of identified funds
• reluctance of organisations to understand the
  positive benefits of pharmaceutical care
• Benefits of change were
• Savings to prescribing costs
• fewer hospital admissions
• patient satisfaction with the service

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Next Steps

• Further staff recruitment to increase capacity
• Work with acute hospitals to develop self
  medication programmes for patients on elderly
  medical wards
• Commission a community based Pharmacy Service to
  benefit all patients
• Continue to demonstrate prevention of hospital
  admission
• Formally evaluate patient satisfaction with the
  new service
• Share best practice and encourage the development
  of a UK National Pharmaceutical Service, for
  patients everywhere

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Future Challenges

• Managing demand of chronic disease
• Identification of priority patients
• Capacity of retail pharmacies to supply MDS in
  sufficient volume
• Provision of ongoing pharmaceutical care for the
  most vulnerable patients
• Changing culture in secondary care regarding
  sharing of information

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Costs of the Service

• Staffing costs 06/07
• 117,323
• Non-staff costs
• Travel etc 5,825
• Pharmacies 79,709
• (400 patients on MDS)
• Total annual cost
• 202,860

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Thank you for listening

• Any Questions?