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

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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?

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

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

Next Steps of HARMs project is to focus on GI bleeds

Bowtie method

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

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 “

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