Problematic Polypharmacy A Pharmacist-Led Intervention Mairead O’Malley

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

Impact at a Glance

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

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.

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

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

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

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

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

What Happened?:   86 patients referred

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.

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

What Happened?:   Place of residence

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

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

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

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

What Happened?:  

What Happened?:  

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.

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

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

Thank you Any Questions? Contact details: mairead.o’malley@bsuh.nhs.uk lisa.radway@nhs.net