Problematic
Polypharmacy
A Pharmacist-Led Intervention
Mairead O’Malley
Academic Health Science Networks
•spread innovation
•improve health, and
•generate economic growth
by connecting
•health and social care
•industry
•researchers, and
•the third and independent sectors
with focus on
• Five Year Forward View
• Sustainability and Transformation Plans
Impact at a Glance
Living Well For Longer
LWFL Vision:
Better health and better care in later life
Living Well For Longer
Context
• Healthcare financial gaps are growing
with deficits among NHS acute providers
of around £2bn. The FYFV forecasts
£30bn deficit across healthcare without
significant efficiency savings.
• Recent predictions still predict a gap of
£17bn.
• Caring for people 65+ accounts for 51%
of gross national authority spending in
adult social care.
• Social care demand has increased 28%
and seen a 31% reduction in funding in
the last five years.
• People with long term conditions account
for 66% of primary care prescribing
budget and 70% of social care spend,
• Dementia is estimated to cost health and
social care more than CVD, stroke &
cancer combined.
The demographic impact of aging
• Increased longevity raises huge
challenges for health and care systems.
• Modern healthcare and society have
transformed our health and social care
needs. Mounting evidence shows that
older people will be more active and
independent than the current
generation.
People aged 65 in England can already
expect to live two more decades.
By 2030, projected life expectancy
at 65 will be 88 for men and 91
for women.
Our strategy describes action in
4 key areas
Principle benefit
1. Reducing unnecessary hospital
admissions
2. Enhancing self management
3. Supporting capability in care homes
4. Aligning ourselves with public health
strategies and early intervention
Better healthcare
experience, and better
value.
Better experience of
care, better health and
better value through
enhancing self
management,
Helping people stay
healthy for longer with
better health and better
value
Living Well for Longer
moves from a strategic
ambition to reality for the
people of Kent Surrey
and Sussex
Justifications
Contribute to the ‘£30bn
challenge’ with a positive
contribution to new
models of care
Contribute to £30bn
challenge to support
people to become less
reliant on clinical input to
manage their conditions.
Living wage drives up
cost & LA’s are paying
less per placement. Care
homes at risk of closing or
providing poor quality
support.
Citizenship and the role of
community within
healthcare. 90% of a
persons health status has
nothing to do with NHS or
Healthcare.
KSS AHSN Polypharmacy Pilot Project:
• 6 month pilot project working with all GP’s in Brighton and Hove
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One Pharmacist and One Pharmacy Technician
Project Management Team at KSS AHSN
Geriatrician (BSUH NHS Trust) and a Brighton and Hove GP
BSUH NHS Trust Pharmacists
Age UK Brighton and Hove
East Sussex Local Pharmaceutical Committee
Brighton and Hove CCG
Brighton and Hove Medical School
• Started Aug 1st 2016
• Aims:
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Support people at risk of a medication related harm or medication
related readmission to secondary care.
work alongside existing pharmacy services to ensure no duplication of
work
identify “gaps” in current service where communication across care
settings fail
Identify cash releasing savings
Current Pharmacy Services in
Brighton and Hove:
NHSE GP
Pharmacists
Better Care/
Proactive Cluster
Pharmacists
CCG
Pharmaceutical
Advisors
Community
Pharmacists
SCfT In-Patient
Rehab
Pharmacy
Service
CRRS Pharmacy
Services
B&H Care
home review
pharmacy
service
Routes of Referral:
1. Age UK crisis line – Age UK currently work to provide
emergency care for patients. They run a crisis line 8am-8pm
7 days a week to take calls from carers, friends, advocates
and patients themselves who may need additional help with
care, shopping, medications etc. They can refer to CRRS if
needs of patient short term <72 hours but will take on
patients themselves for ≥ 14 days.
2. Care Homes/ Rest Homes – care home managers are
being invited to refer to us for medication related queries for
NEW admissions to their care home.
3. BSUH – Pharmacy team, Social work team, HRDT, DISCO’s
4. GP’s – Direct referrals from GP’s for patients who require a
medicine review
Referral Criteria:
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The patient is over 75 or is considered frail
The patient was admitted with a medication related problem
The patient was admitted with Acute Kidney Injury
The patient has had medication changes during their
admission, particularly those where medications are
discontinued, or those requiring titration, monitoring or are
intended only for a short time.
• The patient has 2 or more long term conditions
• The patient is taking 10 or more medications
• The patient has medical or social history indicating a risk or
poor concordance with medications
What Happened?:
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86 patients referred
What Happened?:
• 59 Patients reviewed
• 13 patients refused
• 14 patients reviewed by another service e.g.
• CRRS/IRx,
• Out of Area so we couldn’t review or
• Admitted to hospital before we could review.
What Happened?:
Total number of patients seen (w/c)
What Happened?:
Place of residence
What Happened?:
Average costs saved for each recommendation (115 total recommendations, 38
declined) = £66.17
What Happened?:
Sum of Prescribing, deprescribing and potential deprescribing
What Happened?:
Potentially prevented Hospital Admissions and associated savings
RiO 2=£350
RiO 3=£3500
What Happened?:
Actual
Deprescribing Savings
£6,639.98
Potential
Deprescribing Savings
£10,151.70
£421 per review
What Happened?:
COST SAVINGS PER REVIEW
Savings
£112.54
Includes actual savings made per review
Potential savings
Includes actual savings made per review PLUS the additional potential savings that could have been made
if all recommendations were actioned (i.e. an additional £66.78 per review)
Costs associated with potential hospital admissions avoided
Using RiO scores (and taken the average to calculate figure per review)
Total savings per review
Actual savings per review PLUS costs associated with potential hospital admissions avoided
Potential total savings per review
Potential savings (actual savings PLUS additional potential savings) PLUS costs associated with potential
hospital admissions avoided
Waste identified
Waste medicine removed from patients' homes (not included in total savings)
£172.06
£421.19
£533.73
£593.25
£21.77
What Happened?:
Reflection:
1. The importance of cross sector working
• Many obvious benefits of cross sector working i.e.
reduce duplication of workload by sharing
knowledge. However, information governance
processes around sharing clinical information
should not be underestimated.
2. Taking the TIME to Listen
• Level three medicines reviews offered maximum
benefit to patients when considering changes to a
patients treatment regime. Patients and relatives
feedback was positive with many valuing the time
taken to listen and learn about their situation.
Reflection:
3. Time Vs Money
• Level 3 reviews were well received, however,
patients often required further support – one review
took approximately one and half hours
• Anticipated lower cash releasing savings in
comparison to level 2 reviews, however, savings
were still lower than expected
• Long term benefits of these reviews in patients
regarding ongoing positive effects to health
outcomes?
4. Building Key Relationships
• “Pilot” status may have impacted on number of
referrals particularly from Acute Trust
Reflection:
5. The POWER of partnership working:
• The project’s success was due to good, open working
relationships with a range of organisations across a
number of sectors
• Cross sector working helped to break down barriers
• Linking with Age UK allowed carers to contact us
directly via the crisis team.
• Age UK provided a patient advocate voice to the
project
Thank you
Any Questions?
Contact details:
mairead.o’[email protected]
[email protected]