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The impact of domiciliary medication review in patients at ‘high risk’ of medicines related problems

Central London Community Healthcare (CLCH) NHS Trust ·

Summary

Summary of the example

The Medicine Optimisation pharmacy Service (MOpS) is delivered by clinical pharmacists within CLCH NHS Trust and was commissioned by West London CCG  to address the sub-optimal use of medicines for patients in West London. The purpose of this project was to evaluate the impact of a clinical pharmacy domiciliary medication review service in patients at ‘high risk ’of medicines related problems.

Why we think it’s important

The NICE Medicines Optimisation guide reports that 58% of people aged 60 years and over report having at least one long-term condition. It discusses that between 30% and 50% of medicines prescribed for long-term conditions are not taken as intended. The NHS is not getting the best value for medicines as at least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines.

Learn more about the example

Aims and objectives of the work

The MOpS was designed to address the sub-optimal use of medicines and evaluate the impact of a clinical pharmacy domiciliary medication review service in patients at ‘high risk ’of medicines related problems, i.e. those aged over 75, housebound, taking four or more medicines including “high risk” medicines.

The main objectives were to:

  • Ensure prescribing was safe and evidence based, to optimise clinical outcomes
  • Improve patients’ adherence and optimise medication usage
  • Increase patients’ understanding of their medicines to enable greater self-management
  • Reduce medicines wastage
  • Reduce non elective hospital admissions

Methodology

Two band 8a clinical pharmacists completed level 3 domiciliary clinical medication reviews. A total of 319 visits were completed, including 51 follow up visits. The average age of the patients was 79 years old and ranged from 20 years to 101 years. The average length of the consultation was 58 minutes. An adherence assessment was completed as part of the review and included the patient’s understanding, beliefs and preferences around their medicines. Further support was provided as necessary by the pharmacist including: medication counselling; lifestyle advice; assessing inhaler technique; support for medicine administration and obtaining further supplies of medication. The patient was involved in decisions about their medicines and their pharmaceutical care plan. The plan was agreed with the patient and recommendations made to the GP and multidisciplinary team.. Onward referrals were made by the pharmacists to case managers, district nurses, community pharmacists, social care and specialist nursing teams where required.

Key findings

Results from April 2015 to September 2016 showed a total of 1,741 interventions were made for 268 patients, and 36 (2%) were  grade IV (prevented harm or admission to hospital). The most common intervention by the clinical pharmacist involved advice on stopping a medicine (n=399: 23%), resulting in potential net cost savings of £34,328. Excess medication was removed in 79 patients, amounting to a total value of £7,683.  The average cost of a non-elective admission was £3,571; the 36 grade IV interventions which prevented harm or admission to hospital saved a total of £128,556. Therefore, the total potential saving for 268 patients was £162,884. Out of 64 patients, 61 (91%) were likely or extremely likely to recommend the service to friends and family (FFT test) if they needed similar care or treatment.

Documents

Central London Community Healthcare (CLCH) NHS Trust Poster

Attachments

Background

National guidance, data and publications

The NICE Medicines Optimisation guide discusses that between 30% and 50% of medicines prescribed for long-term conditions are not taken as intended.  The 5 year forward view outlines the NHS vision to increase the direct control patients have over the care that is provided to them. The Royal Pharmaceutical Society produced a guide: Medicines optimisation – helping patients make the most of medicines to support the medicines optimisation agenda. This guide suggests 4 guiding principles for medicines optimisation, aiming to lead to improved patient outcomes. To further support the implementation of the guiding principles, NHS England launched the prototype medicines optimisation dashboard which aims to encourage Clinical Commissioning Groups (CCGs) and trusts to think more about how well their patients are supported to use medicines and less about focusing on cost and volume of drugs.

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