1. Problematic Polypharmacy
A Pharmacist-Led Intervention
Mairead O’Malley

2. 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

3. Impact at a Glance

4. Living Well For Longer Better health and better care in later life
LWFL Vision:
Better health and better care in later life

5. Living Well For Longer Context The demographic impact of aging
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.

6. Our strategy describes action in 4 key areas
Principle benefit
Justifications
Better healthcare experience, and better value.
Contribute to the ‘£30bn challenge’ with a positive contribution to new models of care
1. Reducing unnecessary hospital
admissions
Better experience of care, better health and better value through enhancing self management,
Contribute to £30bn challenge to support people to become less reliant on clinical input to manage their conditions.
2. Enhancing self management
Helping people stay healthy for longer with better health and better value
Living wage drives up cost & LA’s are paying less per placement. Care homes at risk of closing or providing poor quality support.
3. Supporting capability in care homes
4. Aligning ourselves with public health strategies and early intervention
Citizenship and the role of community within healthcare. 90% of a persons health status has nothing to do with NHS or Healthcare.
Living Well for Longer moves from a strategic ambition to reality for the people of Kent Surrey and Sussex

7. KSS AHSN Polypharmacy Pilot Project:
6 month pilot project working with all GP’s in Brighton and Hove
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:
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

8. Current Pharmacy Services in Brighton and Hove:
NHSE GP Pharmacists
Better Care/ Proactive Cluster Pharmacists
CCG Pharmaceutical Advisors
SCfT In-Patient Rehab Pharmacy Service
CRRS Pharmacy Services
B&H Care home review pharmacy service
Community Pharmacists

10. Routes of Referral:
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.
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.
BSUH – Pharmacy team, Social work team, HRDT, DISCO’s
GP’s – Direct referrals from GP’s for patients who require a medicine review

11. Referral Criteria: The patient is over 75 or is considered frail
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

12. What Happened?:
86 patients referred

13. What Happened?: 59 Patients reviewed 13 patients refused
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.

14. What Happened?:
Total number of patients seen (w/c)

15. What Happened?:
Place of residence

16. What Happened?:
Average costs saved for each recommendation (115 total recommendations, 38 declined) = £66.17

17. What Happened?:
Sum of Prescribing, deprescribing and potential deprescribing

18. What Happened?:
Potentially prevented Hospital Admissions and associated savings
RiO 2=£350 RiO 3=£3500

19. What Happened?: £421 per review Actual Deprescribing Savings £6,639.98
Actual
Deprescribing Savings
£6,639.98
Potential
£10,151.70
£421 per review

20. What Happened?:

21. What Happened?:

22. Reflection: 1. The importance of cross sector working
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.

23. Reflection: 3. Time Vs Money 4. Building Key Relationships
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

24. Reflection: 5. The POWER of partnership working:
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

25. Thank you
Any Questions?
Contact details: