Summary of the example
This project was a Pharmacist led optimisation service for older patients with prostate cancer in UCLH NHS Foundation Trust, London. The purpose of the project was to understand the value of a secondary care-led medicines use review (MUR) in prostate cancer patients.
Why we think it’s important
The increasing number of treatment options and an aging population has meant that anecdotally more patients are seen with co-morbidities. The multiple specialisms involved in cancer patient care can lead to no one taking responsibility for the patient as a whole potentially resulting in poorer therapeutic outcomes and in-appropriate polypharmacy.
Learn more about the example
Aims and objectives of the work
To understand the value of a secondary care led Medicines Use Review (MUR) service in prostate cancer patients. Objective(s):
- To evaluate changes in the medicines usage and adherence of prostate cancer patients
- To evaluate change in quality of life and wellbeing of the prostate cancer patients
- To understand service implications and time taken to conduct the MUR
A medicines optimisation framework was developed (and validated by the project board) which included an adaptation of a validated patient adherence tool and EQ-5D’s Health Thermometer, to measure adherence and health state. The framework also included deprescribing criteria which was outlined in the STOPP/START toolkit.
All patients with prostate cancer were eligible to access the service. Patients were identified to attend through a questionnaire that was sent to all prostate cancer patients in December 2015 and also through direct referral from specialist nurses, doctors and pharmacists.
The baseline consultation was completed by a trained oncology pharmacist who would review and make recommendations to the patient and this was followed up with a letter to the GP. A minimum of 1 month after the original review, the patients were asked to complete a questionnaire re-assessing their medicine adherence and health state. Changes in adherence and health state were recorded and outcomes were categorised into 3 areas – clinical, economical and general advice.
Between August 2016 and June 2017, 23 patients were seen in the polypharmacy clinic. Each consultation took approximately 20 minutes, either in person or over the telephone (telephone consultation was equally effective).
At follow up, 23/23 patients (100%) found the clinic beneficial, 11/23 patients (48%) had an improvement in health state (average improvement in patients’ health state was 16%) and 7/23 (30%) had an improvement in their adherence (15/23, 65% had no change in their adherence). The average number of medicines stopped per person ranged from 0-2; overall 14 medicines were stopped in the population seen. Of the interventions made (total of 20) by the oncology pharmacist at the time of consultation, 80% were clinical, 25% were economical and 20% were general advice.
The project highlighted the importance for long term pharmacy input to keep ensuring access to lifelong personalised care, manage chronic diseases and reduce in-appropriate polypharmacy among cancer patients despite there being no direct savings on wasted medications. Further work is planned to move the service to the community.
Presentation at the British Oncology Pharmacy Association (BOPA) 20th Annual Symposium, Glasgow, UK.
National guidance, data and publications
The NICE Medicines Optimisation guideline (2015) discusses the safe and effective use of medicines in health and social care for people taking 1 or more medicines, and aims to ensure that medicines provide the greatest possible benefit to people by encouraging medication review. The Lord Carter report (2016) recommends Hospital Transformation Programmes (HPTP) and that a significant proportion of Trusts’ pharmacist resource is utilised for direct patient-facing medicines optimisation activities. More specifically, the Kings Fund – Polypharmacy and Medicines Optimisation (2013) document describes treatment of diseases in isolation may be less efficient and lead to duplication of care or inconvenience, for example, the same patient may attend several clinics in a short space of time when a single visit would be easier and more productive. Instead of attending several clinics, patients could have all of their chronic disease reviewed in one visit by a team of health care workers. Ideally one team should have responsibility for co-ordinating their care.