EVALUATING MODELS OF MEDICATION OPTIMISATION IN CARE HOMES Wasim Baqir Horsley W, Barrett S, Desai N, Copeland R, Campbell D.

Medicines Use in Care Homes Excess medicines (unnecessary, inappropriate) Lack of structured review Lack of patient involvement

The Northumbria Shine Project Health Foundation funded Develop and test methods to improve medicines use in care homes

Optimise medicines use in Our objective Optimise medicines use in care home residents… …ensuring that residents or their family are fully involved in any decisions around prescribing and stopping medicines

A pragmatic approach Ask three questions Is the medication currently performing a function? Is the medication still appropriate when taking co-morbidities into consideration? Is the medication safe? Also consider Are there medicines missing that the patient should be taking?

MDT Follow up Review Shared Decisions Medicines Screen & review by Shine Pharmacist Review MDT discussion Care home nurses, pharmacist +/- GP MDT Patient, family & carers involved in any decisions Shared Decisions Hotline for urgent advice Follow up

The four models The ‘present’ model The ‘prior’ model The ‘post’ model General practitioner (GP) attendance at MDT meeting Joint decisions between pharmacists & GP The ‘prior’ model GP does not attend the MDT meeting Meets pharmacist prior to the review The ‘post’ model GP meets pharmacist after the MDT meeting Approves or rejects recommendations The ‘absent’ model: No GP

Quality Cost Health economic model Cost:Saving Ratio Interventions Medicines deprescribed Cost Savings from medicines budget Staff costs of running service Cost:Saving Ratio

Demographics N care homes 20 N main care homes (patients) 12 (365) N additional care homes (patients) 8 (57) Nursing:Residential:Mixed 2:3:15 N general practices 16 Average n patients per care home 30.4 patients N patients reviewed 422 residents Age Ave 85.5y (Range 56 to 104) Sex 328 (77.7%) Female

Improving Quality 1346 interventions were made in 382 residents (90.5%)

Deprescribing

Savings £184 saved for every 1 resident reviewed Net Savings £77,852 £184 saved for every 1 resident reviewed >£70 million could be saved across England

Models Present Prior Post Absent Total n patients 160 21 126 115 422 Quality Interventions/ Patient 3.5 3.8 2.7 3.2 Medicine stopped/patient 1.9 2.4 1.2 1.7 Costs Net saving/patient £234 £204 £101 £185 Cost per patient £92 £74 £77 £58 Summary For every £1 invested… £2.54 saved £2.76 £1.30 £3.53 £2.38

Discussion Highest quality and greatest savings when GP involved in the MDT Costly Slight reduction in quality and savings when pharmacists make autonomous decisions However, cost effective

Conclusion Watch our film at www.health.org.uk/pills A pharmacist led medicines optimisation process is a cost effective model improve quality whilst reducing healthcare costs Watch our film at www.health.org.uk/pills