improving the effectiveness of integrated care teams rob darracott pharmacy voice
TRANSCRIPT
Improving the effectiveness of integrated care teams
Rob DarracottPharmacy Voice
Are we really making the most of medicines?
Only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need
Ten days after starting a medicine, almost a third of patients are already non-adherent A study conducted in care homes found that over two thirds of residents were
exposed to one or more medication errors
An estimated 1.7million serious prescribing errors occurred in 2010
In primary care around £300 million of medicines are wasted every year, of which £150 million is avoidable
At least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines
Patient partnership
People differ in their…1. Desire to be involved in treatment decisions2. Perceptions of medicines3. Information needs4. Capacity and resources to adhere to treatment
We need to5. Identify individual needs and preferences6. TAILOR interventions to address:
- misconceptions, concerns and information needs- practical problems reducing patients’ ability to adhere to medicines
How might it look in practice?
Prescribing Cashing Dispensing Taking Clinical outcome 0
20
40
60
80
100
% e
rror
free
at e
ach
stag
e
Quality filterNNT = 2NNT = 10
© Garfield, Barber, Willson, Walley
Solutions
In excess of £450million per annum
Asthma £90million Statins for prevention of cardiovascular disease £75million Type 2 diabetes over £100million Hypertension over £100million Schizophrenia £113million
Cost savings per year that could be realised by increasing the proportion of patients who are compliant with their medicines to 80%
98% of respondents to the on-line Pharmacy survey reported strong evidence of skills enhancement as a result of the project
since the project, the number of MURs related to inhaler technique has continued to increase
over 4,500 Asthma Control Test (Medicine Use Reviews) MURs, 600 follow-up Asthma Control Test MURs and 828 COPD Assessment Test pre- and post MURs 40%
of asthma patients showed better asthma control over
the time period
55%of COPD patients showed
an improvement in symptom management
positive association between the introduction of the project and changes in hospital emergency admissions
use of ‘second intervention’ MURs enabled participants to see the impact of the intervention very quickly, maintaining motivation
Inhaler Technique Improvement Programme
Community Pharmacy Future Project
£139min reduced use of NHS and social services resources, societal costs and increased uptake of flu vaccinations
£86m in disease-related cost savings from supporting people to stop smoking
Customers identified by pharmacies
Customer completes risk assessment
Higher risk?
Micro-spirometry
Refer to GPPublic health advice given
No Yes
• Regular smokers• Purchasing cough mixture
regularly• On medicines for chest
exacerbations• Self-referral
Significant improvements in patient-reported adherence access and utilisation of
rescue packs quality of life reduction in routine GP
visits
Smoking quit rate of 13.85%
Community pharmacy supporting patients using high-risk medicinesAudit carried out in 2,773 pharmacies, of 48,000 patients using methotrexate, warfarin and lithium
Over 13,000 people said they did not have a record book
Nearly 14% of patients were not having regular blood teststo check they are receiving the correct dose
425 patients exhibited some signs of toxicity and were referred to their prescriber
2012-13 Practice-based Audit
