Proactive Care Pharmacy Services

Transcription

1 Proactive Care Pharmacy Services Achieving excellence and efficiency in holistic domiciliary care Kayt Blythin Senior Clinical pharmacist Proactive Care Coastal 20 Jan 2015; update June 2015

2 Proactive Care Pharmacy Services The Proactive Care Service Aims, model and activities Achievements Proactive Care Pharmacy Service activities Impact of service Service development Questions

3 Proactive Care Service Aims Service Aims Independent living Reduce predictable hospital admissions Context - Coastal West Sussex 23% of 480,000 population over 65 years old 1 Communities amongst national 10% most deprived 1. Coastal West Sussex Clinical Commissioning Group. Coastal Delivery Plan , Our Transition and QIPP Delivery. March 2012.

4 The Proactive Care Service Holistic Health and social care teamwork Multidisciplinary meetings Team Lead Coordinator Clinical Nurse Lead OT, Physio MHN Pharmacist PAT Social Worker DN Case Manager District Nurses

5 The Proactive Care Service - How? Patient referrals long term conditions, complex comorbidities, risk hospital admission Consent MDT meeting - case discussion and needs identification Home visits - assessment and actions Contingency plan

6 Pharmacist Role - MDT MDT Identify patients for medication review Update on patients reviewed Clinical prescription screen Provide expert pharmaceutical information Promote quality, safe and cost-effective prescribing Feedback from GP on interventions made

7 Pharmacist Role home visit and cost-effective prescribing Pre visit GP summary, prior assessments, relevant clinical letters Visit Proactive care introduction Medication review - patient focussed non medicines needs Post visit Pharmacy, GP/patient letters, contingency plan, - Feedback GP, follow up, data entry

8 Proactive Care Pharmacy - Outcomes Medicines optimisation Improved adherence and self management Potentially avoided hospital admissions Reduced medicines related risks Reduction in polypharmacy and waste Reduction in prescribing costs Improved communication with community pharmacy Medicines information source for team

9 Case Example Norman Background Referral SW 85y old male - codeine tablets lying around house,? taking medicines. Medical History T2DM, retinopathy, angina, depression, MI, back pain, falls. Rx; gliclazide, metformin, amitriptyline, zopiclone, mirtazapine, solifenacin, aspirin, paracetamol, simvastatin, hydroxocobalamin, lactulose, MST. Social lives alone, house dirty

10 Case Example Norman Home visit Issues: Blister pack tea time doses antidiabetics not taken prn MST and codiene not taken but regular supplies HbA1C 6.4% with poor adherence Poor vision Falls risk - zopiclone, mirtazapine, amitriptyline, opiates Contraindication amitriptyline & cardiac history Low mood constipation

11 Case Example Norman Interventions Tea time medicines changed to MR Gliclazide stopped; repeat HbA1C 2-3 months & review MH: Increased Mirtazepine, stopped Zopiclone & amitriptyline Pain; Stopped MST & codeine, regular paracetamol Discussed prompts for adherence Community pharmacy - large print, disposal XS, stop supply codeine

12 Case Example Norman Outcomes Health Pain well controlled Mood improved, Less constipated, no falls reported Quality Reduced polypharmacy, appropriate & evidence based medicines, reduced waste, reduced risk interactions, adverse effects and falls. Savings Potential admission avoided 1948 Medicines rationalised 24.54/y

13 Overall Benefits Proactive Care TOTAL Service: at 12 months 5361 patients with shared CP 919 calls to 999 of which 624 NOT conveyed Conveyance rate 32% vs 67% without CP Est. 52M 5 year savings

14 Pharnacy Benefits Proactive Care Pharmacy service: at 12 months 1178 medicines reviews 1125 resulted in a reduced risk of harm from medications 236 had an impact score of 3 or 4 (contributing to reduced risk of hospital admission) 49,560 saved by de-prescribing

15 Proactive Care Pharmacy Services Achieving excellence and efficiency in holistic domiciliary care