Medicines OptimisationHow can data help us to get it right?

Clare Howard FFRPS FRPharmS

Medicines Optimisation Principles

Medicines Optimisation – The Strategic Context

PPRS - NHS England response to PPRS agreement• “Ensuring medicines use is patient centred and focused on

value, quality and outcomes will help seize the opportunity of the 2014 PPRS agreement”

• Kings Fund Poly Pharmacy and Medicines Optimisation

• NICE short clinical guideline published 2015

What key messages do they have?

NICE GUIDANCE (NG5) • Between 2003 and 2013 the

average number of prescriptions for any one person per year in England rose from 13 to 19

Better use of data Patient centered care ( including

shared decision making ) Transfer of care Medication safety

Kings Fund • In problematic

polypharmacy, there can be increased risk of drug interactions and ADRs, impaired adherence and QoL for patients

The role of data

NICE says “The better use of data and technology can give people more control over their health and supports Medicines Optimisation”Data sources include:NHS England MO dashboard.MHRA yellow card schemeNational Reporting and Learning SystemNHS Safety Thermometer

What have patients told us?

Improve national awareness amongst patients, the public and professionals of the services available to support patients in their medicines-taking 

Enrich ‘consultations’ (in all care settings) to support health and care professionals to more closely consider the life stage/ patient perspective (see NICE Guidance)

Encourage patients to be more responsible and honest about their attitudes and behaviours around medicines-taking, including not wishing to take them

Encourage the provision of better information & support to enable patients/ carers to get the best from their medicines

Ensure that the view of patients and the public around waste, repeats, and broader system improvements on medicines-taking are incorporated into the Value for Money element of any strategy.

6

So what does the data tell us about NEL, Anglia, Bedfordshire, Hertfordshire and Luton?

Nobody has cracked this.Lots more opportunities to use community pharmacy.London area doing a lot with Repeat DispensingEveryone is waiting for something that will fix this but many of the tools are already in the box but we’re not using them!

Use of tools proven to improve medication safety

Use of tools proven to improve medication safety

Use of services proven to support patients’ access to medicines and reduce GP workload

Use of services proven to support patients’ access to medicines and reduce GP workload

Medicines Reconciliation

Medicines Reconciliation

NHS Safety Thermometer

Medication safety – a reporting culture

Medication safety – improving harm free care

Use of services known to increase adherence to medicines

Use of services known to increase adherence to medicines

Use of services known to support patients in their medicines taking

Use of services known to support patients in their medicines taking

Access to Summary Care Record

Prescribing of antibacterials

Use of antibiotics known to increase the risk of C. Diff by CCG

Adoption of NICE approved medicines

So what’s the answer?• There isn’t one - There are lots

PRACTICE PHARMACISTS?

Greater use of the Community

Pharmacy Services already available

Use of the STOPP START tool to

reduce inappropriate polypharmacy

Patient awareness of the services

they should expect as routine

CCGs and CSUs role in making

sure GP practices are aware of

PINCER, PRIMIS etc

Joining up the system - refer to

Pharmacy, Discharge MURs,

NMS

and finally..

• Data is key to all of this.• Eventually if we don’t put all this in place we wont

have the assurance that medicines are being used well, so investment in new medicines that help patients will be much riskier. This is unfair to patients who could benefit those medicines.

• Or if we do get it right, we can be assured that patients will use medicines well and therefore the price tag becomes less of a focus.