MEDICINES and Older People Hira Singh Prescribing Adviser (Middlesbrough PCT and Redcar & Cleveland PCT Medicines Management Team) March 2008

Who are we? Medicines Management Team Pharmacists Pharmacy Technicians Data Analyst Project Manager

What are Medicines Management Services? Successful MM services will ensure that patients, professionals and the NHS get maximum benefit from the use of medicines. All aspects of supply and therapeutic use of medicines from individual patient level to an organisational level are covered. That’s why we want best value for money! £50m spent on drugs in primary care across South Tees.

NSF for Older People (March 2001) Medicines Supplement AIMS To ensure that older people: gain maximum benefit from their medicines to maintain and increase their quality and duration of life. Do not suffer unnecessarily from illness caused by excessive, inappropriate or inadequate consumption of medicines. Are not denied access to medicines that would benefit them

Some Statistics….. Approx. half the NHS drugs bill is spent on older people 80% of over 75s take at least one medicine and 36% take 4 or more. Adverse reactions to medicines account for 5 – 17% of hospital admissions in older people. The number of people aged over 85 is set to rise by nearly 75% by 2025 (DoH Jan 2006)

COMPLIANCECONCORDANCE COMPLIANCE OR CONCORDANCE As many as 50% of older people may not be taking medicines as intended –Why might this be? –(communication between primary & secondary care) Older people and their carers need to be more involved in decisions about their treatment. Older people and their carers need more information about the risks and benefits of their treatment.

PRIMARY / SECONDARY INTERFACE ISSUES Poor two-way communication between hospitals and primary care Changes in medication after discharge from hospital (unintentional changes are too frequent)

ACCESS TO INFORMATION AND SUPPORT Access to pharmacy or surgery may be difficult, reducing contact with a range of health professionals. Carer’s potential contribution and needs are often not addressed (Informal and formal carers) Advice on practical aspects of medicine taking may be lacking.

Prescribing medicines is the most frequent NHS healthcare intervention Medicines Management team have been involved with: Falls FallsMental Health Continence Stroke Intermediate Care Review of repeat prescribing systems Care Homes Medication reviewEducation / Training Training included awareness sessions on medicines for hospital social workers, carers etc

Settings Home (independent) Sheltered housing Home –with domiciliary care Respite careIntermediate care Long term residential care Acute hospital care Home with informal carer support

Who may be involved Who may be involved With prescribing & managing medicines? Informal carers Domiciliary Care providers District Nurses GP Consultant Pharmacist – community, primary or secondary care Care Home staff (nursing or non- nursing) Social Care Intermediate Care staff

What have we done so far? In Care Home clinical medication review for residents medicines policies and procedures (in home care setting) training for staff o Worked to improve good quality training for carers in medicines o South of Tees Group / Regionally Care Home Advisory Pharmacist NB ‘Handled with Care’ report CSCI Practice Pharmacist in every GP Surgery

Domiciliary Care Part of a Multi-agency working group Its Aims: - To promote independence and safe, effective use of medicines Standardise policies across South Tees Reduce reliance on MDS as the only means of support Consider health /social care boundary issues Decrease admissions to long term care by improving safe & effective use of medicines

Intermediate Care Pharmaceutical Care Award for pharmacy technician project Cross-boundary working (strategic group) Accessible to social care teams Links with clinical medication review in practices

Medicines Awareness Sessions Local Authority employed carers Social Workers Discharge liaison teams District Nurses Occupational therapists Intermediate Care teams

.. and patients and carers? Information leaflets (Medicines and Falls) ‘Sloppy Slipper’ events Talks to older peoples groups / carers groups Ask About Medicines Week – in older peoples clubs/nursing homes, council day centres & friendship groups. PCT Life Store Medication Review

How do we make more progress? Joint working collect good information about why things go wrong – share it, and learn from it! discharge planning and process more access to pharmacist help in social care settings ensure access to good quality training /education about medicines for all staff handling medicines.