![There is no impending pharmaceutical
discovery, surgical innovation or
governmental policy change with
greater potential for improving the
health of patients and efficiency of the
health care system, than simply
increasing the percentage of treatment
plans that patients (are able to) carry
out as prescribed
[Align Map www.alignmap.com ]](https://image.slidesharecdn.com/optimizepresentationjune13-130625060657-phpapp01/85/Optimize-Presentation-2-320.jpg)
![“Drugs don’t work in patients who don’t take them” C. Everett Koop M.D – Surgeon General
USA 1982-89
It is estimated that 50% of all prescribed medication is not used by patients
as intended by the prescriber [ Sackett D.L., Snow J.C. “The Magnitude of Compliance & Non-Compliance” In:
Haynes R.B. et al (Eds) “Compliance in Health Care” Baltimore, John Hopkins University Press 1979; Nov 22]
It has been estimated that between 20 and 50% of patients are not
adherent to their medication regimeKripalani S, Yao X, Haynes RB. Interventions to Enhance
medication Adherence in Chronic Medical Conditions: A systemic Review. Archives of Internal medicine 2007; 167:540-550
Improving medicine taking may have a far greater impact on clinical
outcomes than an improvement in treatments Haynes R.B., Ackloo E., Sahota N., McDonald H.,
Yao X. “Interventions for Enhancing Medication Adherence” Cochrane Database System Review 2008; (CD0000011)
33-69% of all medicine related hospital admissions are due to poor
medication adherenceOsterberg & Blaschke. New England Journal of Medicine 2005 Vol 353
Only 4 to 21% of patients are receiving the optimum benefit from their
medicines Garfield S, Barber N, Walley P, Willson A, Eliasson L. Quality of Medication Use in Primary Care - Mapping the
Problems, Working to a Solution: A Systemic Review of the Literature. BMC Medicine 2009; 7:50](https://image.slidesharecdn.com/optimizepresentationjune13-130625060657-phpapp01/85/Optimize-Presentation-3-320.jpg)
More Related Content
![Chapter 1[1]](https://cdn.slidesharecdn.com/ss_thumbnails/chapter11-150306090427-conversion-gate01-thumbnail.jpg?width=560&fit=bounds)
Similar to Optimize Presentation (20)
Optimize Presentation
- 1. Optimize© - A Medicines Adherence Solution provided by Green Light Pharmacy in it’s Stepney branch commissioned by Tower Hamlets PCT in 2012 & now by NHS England
- 2. There is no impending pharmaceutical discovery, surgical innovation or governmental policy change with greater potential for improving the health of patients and efficiency of the health care system, than simply increasing the percentage of treatment plans that patients (are able to) carry out as prescribed [Align Map www.alignmap.com ]
- 3. “Drugs don’t work in patients who don’t take them” C. Everett Koop M.D – Surgeon General USA 1982-89 It is estimated that 50% of all prescribed medication is not used by patients as intended by the prescriber [ Sackett D.L., Snow J.C. “The Magnitude of Compliance & Non-Compliance” In: Haynes R.B. et al (Eds) “Compliance in Health Care” Baltimore, John Hopkins University Press 1979; Nov 22] It has been estimated that between 20 and 50% of patients are not adherent to their medication regimeKripalani S, Yao X, Haynes RB. Interventions to Enhance medication Adherence in Chronic Medical Conditions: A systemic Review. Archives of Internal medicine 2007; 167:540-550 Improving medicine taking may have a far greater impact on clinical outcomes than an improvement in treatments Haynes R.B., Ackloo E., Sahota N., McDonald H., Yao X. “Interventions for Enhancing Medication Adherence” Cochrane Database System Review 2008; (CD0000011) 33-69% of all medicine related hospital admissions are due to poor medication adherenceOsterberg & Blaschke. New England Journal of Medicine 2005 Vol 353 Only 4 to 21% of patients are receiving the optimum benefit from their medicines Garfield S, Barber N, Walley P, Willson A, Eliasson L. Quality of Medication Use in Primary Care - Mapping the Problems, Working to a Solution: A Systemic Review of the Literature. BMC Medicine 2009; 7:50
- 4. • To support independent living • To improve patient adherence with therapy by – Improving understanding – Identifying practical problems – Supporting the carer • To reduce wastage and thus make cost savings by decreasing the local prescribing budget • To help people manage their medicines safely & appropriately • To decrease Preventable Medication Related Hospital Admissions and thus make cost savings to the CCG’s Hospital Admissions budget
- 5. The service focuses on improving, supporting & monitoring adherence (how people take their meds) not simply on the provision of compliance devices (ie not just a blister pack, other solutions as well)
- 8. Optimize© addresses: Unintentional non compliance • Access (eg over / under script request) • Physical issues (using inhalers, reading English) • Adherence solutions (Blister Packs , Reminder Charts, prompts eg phone call, text, phone aps ) Intentional non- compliance • Cognitive support • Meds Education Plan • Patient held meds record - their “Medication Passport” • Condition Education Plan • Adherence Record • Reward Plan • Relapse Plan
- 9. Optimize©:A Medicines Adherence Solution Referral Adherence Assessment by AccreditedCP Support Plan & Report (SPAR), carried out by patient’s usual, localCP. (Compliance aids; cognitive support; use of MAR sheets; reminders/prompts) Discharge from service, but with on-going Support Plan Review (initially at 3 months, then every 6 months) Evaluation of Referral by Accredited Community Pharmacist (CP) Patient referred to other health & social care services and/or contacted by accredited pharmacist to discuss the reason for the referral and possible solutions. Inappropriate Referral Appropriate Referral Adherence Evaluation by Accredited CP (usually as a domiciliary visit) Adherence MUR Plus by AccreditedCP Support Plan Communicated to the patient, as user friendly (patient held) Medicines Passport Patient carries on in the service Annual Report & Evaluation of Service to Commissioner by Service Provider
- 10. What’s the service? Adherence Assessment (AA) followed by a Support Plan and Report (SPAR). People requiring ongoing support will be referred onto Optimize Adherence Support Service for tailor-made adherence support. Who can refer? Any CCG / LA approved body Which patients need the service? Patients with long-term conditions who have difficulty taking, or remembering to take, their medicines; complex and high need patients only. Who provides the service? – Hub & Spoke model • Assessments by Accredited Community Pharmacists (hub) • The patient’s presant local (Accredited) Community Pharmacist (spoke) How will we link to other services (for referral and for reporting)? • Community nurses • GP practices •Multi-disciplinaryGroups •Social Care Organisations • Pharmacy network • Hospital discharge department • Pathway design (CCG, locality/network etc) What do we report? • Patient review • Info the GP requires. • Cost savings of recommendations • Summary of health outcomes for patients in scheme • Patient satisfaction surveys • Assessment of data from stakeholders Optimize©: A Medicines Adherence Solution
- 11. What we were not commissioned to provide – but on reflection would be useful • IT platform • Training of Pharmacy Staff in other pharmacies for roll out of service • Whole team training (GPs, Nurses, & other Health & Social Care Professionals)
- 12. Optimize© Referral Form Confusion on taking medication Remembering to take medication is a problem (eg evidence of missed doses) Assistance required to physically take medication (eg dexterity issues) Medications are not synchronised on prescription, requiring extra visits to the Dr / Pharmacy Difficulty in maintaining supply of medication evident (eg stockpiling or running out of medication) Patient forgetting to request repeat prescriptions Health Literacy (eg difficulty understanding & reading medication labels / non-English literate, lack of understanding of meds or medical condition) Prescribing Interval to be reassessed (eg patient is on 7 day prescriptions -might imply adherence issues) Patient has requested help in taking medicines Intentional non-adherence (ie patient intentionally choosing to not take medication) High Risk Patient (eg onVirtualWard, Frequent HospitalAdmissions)
- 13. Optimize© Adherence Evaluation (Part 1) MMAS-8 Questions. Note for pharmacist - If repeating questionnaire after 6 month please preference each question with the phrase “since we last spoke …...” You are taking medication(s) for your condition. Individuals have identified several issues regarding their medication taking behaviour and we are interested in your experiences. There is no right or wrong answer. Please answer each question based on your personal experience with your new medication. Do you sometimes forget to take your medicine(s)? Yes No People sometimes miss taking their medications for reasons other than forgetting. Thinking over the past two weeks, were there any days when you did not take your medicine(s)? Yes No Have you ever cut back or stopped taking your medication without telling your doctor because you felt worse when you took it? Yes No When you travel or leave home, do you sometimes forget to bring along your medication? Yes No Did you take your medicine(s) yesterday? Yes No When you feel like your condition is under control, do you sometimes stop taking your medicine? Yes No Taking medicine everyday is a real inconvenience for some people. Do you ever feel hassled about sticking to your medicine treatment plan? Yes No How often do you have difficulty remembering to take all your medications? Never / Rarely One in while Sometimes Usually All the time
- 14. Optimize© Adherence Evaluation (Part 2) BMQ Questions. I would like to ask you about your PERSONAL VIEWS about the medicines prescribed for you. Note for pharmacist - If repeating questionnaire after 6 month please preference with the phrase “since we last spoke …...” Please indicate how much you agree or disagree with the following statements about your medicine by answering the following. There are no right or wrong answers. We are interested in your personal views. Tick the appropriate box Strongly agree Agree Uncertain Disagree Strongly disagree 1) My health, at present, depends on my medicine(s) 2) Having to take my medicine(s) worries me 3) Without my medicine(s) I would be very ill 4) My life would be impossible without my medicine(s) 5) I sometimes worry about long term effects of my medicine(s) 6) My medicine(s) are a mystery to me 7) My health in the future will depend on my medicine(s) 8) My medicine(s) disrupts my life 9) I sometimes worry about becoming too dependent on my medicine(s) 10) My medicine(s) protects me from becoming worse
- 15. Optimize© Adherence MUR Plus (Page 1) Patient name & address Attach Patient's PMR Bag Label Here DOB Total number of medicines being used by patient: Ethnicity Prescribed Gender OTC & complementary therapies Pharmacist name: Date: Suggested questions Complete GLMAS Patient Evaluation Questionnaire Form with patient at start of interview Yes / No 1. How are you getting on with your medicines? 2. How do you take or use each of these medicines? 3. Are you having any problems with any of your medicines, or concerns about taking or using them? Medicines not listed on the patient’s PMR Dosage Notes (include if OTC or prescribed. If prescribed from GP or Hosp etc) Consultation notes List ALL meds patient is on from GP / Hospital etc with prescribed dosages (can attach a copy of patient's Repeat Request Form or PMR record print out). List actual dosages that the patient takes (can do this on the Repeat Form or PMR print our). List any significant side effects. Can use codes from GL MUR referral sheet as “short codes” Group Q4 & Q5 by therapeutic areas 4. Do you think they are working? Prompt: is this different from what you were expecting? 5. Do you think you are getting any side effects or unexpected effects? 6. People often miss taking doses of their medicines, for a wide range of reasons. Have you missed any doses of your medicine, or changed when you take it? Prompt: when did you last miss a dose? 7. Do you have anything else you would like to know about your medicines or is there anything you would like me to go over again? Prompt: Are you happy with the information you have on your medicines?
- 16. Optimize© Adherence MUR Plus (Page 2) Is a Compliance Aid being used now. Patient's views of it's usefulness. Prompt: How does the Compliance Aid help you ? Evidence of intentional non-compliance. Why is patient intentionally non-compliant? How does person order / collect prescriptions?. Which pharmacy do they use ? Do they remember to order medicines? What about PRNs & non MDS medication Is there duplication of medication due to supply from different pharmacies (including hospital) ? How do medicines get delivered to the patient ? Is there evidence of stockpiling or running out of meds. (Check patient's actual stock of meds: list excess meds & quantities of patient's stock) Does patient order all medicines together or at different times? Can person read all labels? Yes / No Can the person read English ? Yes / No Can they open and close all containers? Yes / No Dexterity – able to push tablets out of blisters, pick up small tablets, halve tablets? Yes / No Can they measure any liquid medicines ? Yes / No Inhalers / eye drops – check technique / able to administer correctly? Yes / No Are they able to swallow their medicines? Yes / No Is person aware of time (day) and place? Yes / No Assess if any of the following would be helpful (please circle) Hand written labels, Large print labels, Symbols / colour coding, Easy open lids, Large bottles, Pop blister meds into bottle, Halve tablets, Haleraid, Spacer , Eye drop dispenser, Different formulation, Measuring cup / oral syringe, Other What systems do they use to remind them to take their medicines? Does someone help patient take their medicines? Who? Does this person prompt or actually administer? Is this person able to help patient with all doses on all days? (check weekends / evenings) Does person have a compliance aid already – what type/ who fills it? Who initiated the compliance aid in the first place ? (GP, Patient, Nurse, CP etc) What condition is the compliance aid in ? (clean, labelled, legible?) Adherence to ‘prn’ medicines, medicines unstable in compliance aid, inhalers, creams etc ? Note to Pharmacist - Remember to take medicines for disposal. Other issues (eg frequent attendance at Urgent Care Centre, A&E)
- 17. Optimize© Adherence MUR Plus (Page 3) Name Strength & Form of medicine Approximate quantity Approximate cost (based on present DT price can be completed in the Pharmacy) Reason for disposal RIO score Please list medicines no longer required taken for disposal I agree to the above medication being removed for safe disposal by the pharmacist Signature of patient …………………………...…..…......... Signature of pharmacist ……….....................Date …… RIO scoring: 1 – no likelihood of preventing an emergency admission, 2 – possibly may prevent an emergency admission, 3 – likely to prevent an emergency admission
- 18. Optimize© Adherence Assessment & Support Plan, including Patient’s Medication Passport (Meds Usage Issues) Actions required for MedicinesUsage Issue (Assessor to tick which were identified from assessment): Improve the patient’s actual use of their medicines Improve the patient’s understanding of their medicines Improve the patient’s experience of taking their medicines Address any issues with any meds with inadequate dosage instructions (ie as directed) & PRN meds with the prescriber Address side effects (patient reported or clinically identified) and drug interactions that may affect the patient’s adherence with the prescriber Recommendations from review of the clinical and cost effectiveness of drugs prescribed. From review of the clinical and cost effectiveness of drugs prescribed itemise here potential cost savings. Include proposals for changing brands to generics (& vice versa) if appropriate; non-use / under use of meds by patient (eg evidence from meds patient requested for disposal) Change existingAdherence Solution to a more suitable one Discus with prescriber altering the prescribing interval so patient does not run out / have excess medication Improve the patient’s baseline understanding of their condition(s) Improve the patient’s interpretation of a healthy lifestyle Address intentional non-compliance issues Other -
- 19. Optimize© Adherence Assessment & Support Plan, including Patient’s Medication Passport (Meds Access Issues) Actions required for Access Issue (Assessor to tick which were identified from assessment): Prescription ordering service Prescription Collection service Prescription Delivery Service Prescription Synchronisation Duplication of medication due to supply from different pharmacies (including hospital) Stockpiling (excess stock with patient. Reference- 6 month ordering history from GP records or Pharmacy PMR) Other -
- 20. Optimize© Adherence Assessment & Support Plan, including Patient’s Medication Passport (Physical Issues) Actions required for Physical Issue (Assessor to tick which were identified from assessment): Use of aids including: o Hand written labels (ie written in a different language) o Large print labels o Symbols / colour coding o Easy open lids; Large bottles o Pop blister meds into bottle o Halve tablets o Haleraid; Haleraid o Eye drop dispenser o Eye drop dispenser o Measuring cup / oral syringe
- 21. Optimize© Adherence Assessment & Support Plan, including Patient’s Medication Passport (Adherence Solutions) Actions required for Adherence Solution Issue: (Assessor to tick which were identified from assessment) Simplify dosage regime (discus with prescriber) Support carers (formal or informal carers) re medicines oversight. This includes supply of meds & meds education (eg to enable identification of adverse effects) Link medication to daily routine with reminders & prompts Supply Medication Reminder Chart (MR Chart) (A list of all meds & when to take) (Use Medication Reminder Chart specified in SLA) Supply MedicationAdministration Records chart (MAR)Chart (use MAR Chart specified in SLA). o Retain used MAR charts , use to make notes of patient's on-going Adherence Provide a reminder mechanism for prompting medication adherence (eg phone calls, texting, e-mails, phone ap). o Specify reminder mechanism chosen here: Supply medication in multi-compartment compliance aid o Analyse used Blister Packs & make notes of patient's on-going Adherence Supply cogitative support: Educational Plan to increase patient/carer understanding of the underlying conditions Supply cogitative support: Educational Plan to increase patient/carer understanding how their medication works Supply cogitative support : Adherence Record Chart (AR Chart) (similar to a MAR but actually asks the patient/carer to record the reason why a medication was missed or intentionally not taken) o Retain used Adherence Record Charts , use to make notes of patient's on-going Adherence Supply cogitative support: Reward Plan. o Details of Reward Plan: Supply cogitative support Relapse Plan o Details of Relapse Plan: If patient is not aware of time or place then the patient will need support from informal carer (family / friend , or formal carers (eg Social Care Support, Community Nurse support) for medication administration. o Details of Informal or Formal Support : Other -
- 22. Unused Meds, collected from just ONE patient, prior to joining Optimize© service
- 23. Evaluation of Data Due end July 2013 (from 1st six months of service) Evaluation will be supported by UCL
- 24. Any Questions ? [email protected] Optimize© Green Light Healthcare Ltd January 2012