Improving the effectiveness of integrated care teams Rob Darracott Pharmacy Voice

Are we really making the most of medicines?  Only 16% of patients prescribed a new medicine take it as prescribed, experience no problems and receive as much information as they need  Ten days after starting a medicine, almost a third of patients are already non-adherent  A study conducted in care homes found that over two thirds of residents were exposed to one or more medication errors  An estimated 1.7million serious prescribing errors occurred in 2010  In primary care around £300 million of medicines are wasted every year, of which £150 million is avoidable  At least 6% of emergency re-admissions are caused by avoidable adverse reactions to medicines

Patient partnership People differ in their… 1.Desire to be involved in treatment decisions 2.Perceptions of medicines 3.Information needs 4.Capacity and resources to adhere to treatment We need to 1.Identify individual needs and preferences 2.TAILOR interventions to address: -misconceptions, concerns and information needs -practical problems reducing patients’ ability to adhere to medicines How might it look in practice?

© Garfield, Barber, Willson, Walley

Solutions In excess of £450million per annum  Asthma £90million  Statins for prevention of cardiovascular disease £75million  Type 2 diabetes over £100million  Hypertension over £100million  Schizophrenia £113million Cost savings per year that could be realised by increasing the proportion of patients who are compliant with their medicines to 80%

98% of respondents to the on-line Pharmacy survey reported strong evidence of skills enhancement as a result of the project since the project, the number of MURs related to inhaler technique has continued to increase over 4,500 Asthma Control Test (Medicine Use Reviews) MURs, 600 follow-up Asthma Control Test MURs and 828 COPD Assessment Test pre- and post MURs 40% of asthma patients showed better asthma control over the time period 55% of COPD patients showed an improvement in symptom management positive association between the introduction of the project and changes in hospital emergency admissions use of ‘second intervention’ MURs enabled participants to see the impact of the intervention very quickly, maintaining motivation Inhaler Technique Improvement Programme     

Community Pharmacy Future Project £139m in reduced use of NHS and social services resources, societal costs and increased uptake of flu vaccinations £86m in disease-related cost savings from supporting people to stop smoking Customers identified by pharmacies Customer completes risk assessment Higher risk? Micro- spirometry Refer to GP Public health advice given No Yes Regular smokers Purchasing cough mixture regularly On medicines for chest exacerbations Self-referral Significant improvements in  patient-reported adherence  access and utilisation of rescue packs  quality of life  reduction in routine GP visits Smoking quit rate of 13.85%

Community pharmacy supporting patients using high-risk medicines Audit carried out in 2,773 pharmacies, of 48,000 patients using methotrexate, warfarin and lithium Over 13,000 people said they did not have a record book Nearly 14% of patients were not having regular blood tests to check they are receiving the correct dose 425 patients exhibited some signs of toxicity and were referred to their prescriber    Practice-based Audit