1. Dudley CCG plans for population health and managing polypharmacy and de-prescribing
Clair Huckerby
Consultant Pharmacist
Primary Care and Medicines Optimisation

3. 3

5. Managing Polypharmacy and de-prescribing
De-prescribing – the cure for the disease of polypharmacy
De-prescribing – the process of tapering, stopping or withdrawing unnecessary and inappropriate medicines
Dilemma- which medicines do you discontinue?

6. Is it worth it?
Meds rec (Karnon et al) evaluated that ROI was £13.64 per patient for meds rec by a pharmacist
variation according to skill set
meds rec is everyone's business
If one drug with an average unit
cost of £9.87 (and an average
6 repeats) is stopped for one
year – this would reduce
prescribing costs by ~£72,000 per
100,000 population
It is estimated that the cost of
hospitalisation due to avoidable ADRs is
between £58,500 and £407,000 per

7. Systematic, population-based and data-driven
Strategic
Operational
Tactical

9. Next Steps of HARMs project is to focus on GI bleeds

10. Bowtie method

11. Practice Based Pharmacists Outcomes 2016/17
58,294 patients reviewed
45,713 interventions documented
4,310 dose optimisations
planned changes (5,824 generic and 3,621 branded)
4,447 drug discontinuations
4,424 preventative medicines initiated
1,543 concordance and compliance issues resolved
1,136 safety issues addressed
2,152 formulary issues resolved
16,473 medicines reconciliation completed
16,556 changes to medicines actioned
Medications reviews completed in 5,050 patients with LTC’s and 1147 patients newly discharged from hospital, 105 housebound patients, 375 patients in Care Homes, 3,364 patients on 5 or more medicines with 2 or more LTCs, 5,578 reauthorisations. Saving at least £174K on these medication review related interventions
369 HARMS related interventions accepted
170 patients newly diagnosed with hypertension

12. Dudley POD-Initial activity and interventions/ impact
£76.5K of GP time saved between October and July- over 3 practices
This is approx. £38K per year per practice of GP time potentially saved (£1.7m for whole CCG) on top of the items reduction associated savings
“for every £1 invested in PBP provision, savings of £4.73 may be realised “

14. Recommendations in order to get population focus
Strong clinical leadership- overarching and peer review
Pharmacists focussing on their area of expertise- working as part of an MDT
Applying national and local strategy and operationalising it
Providing Systems Leadership
Understand population needs
Prioritise those needs
Numbers
Impact
Ability to modify risk
Design interventions and using innovation
Implement- new service models e.g. POD
Review and measure