Risk Stratification and Medicines Optimisation Helen Liddell Leeds South & East CCG

Why Risk Stratification What is Risk Strat? Limitations of Risk Stratification What implications for Medicines Optimisation

Why? People want to stay in their home as long as possible NHS funding requires reduction in unplanned admissions Reducing patient harm New GP DES - Unplanned admissions Enhanced Service

4 The workload / cost distribution Emergency admissions are draining resources. They account for the most cost and days 56% PBR budget is allocated to emergency care for 160K£215M Source:NHSIC. Data Leeds CCGs 11/12

What? Risk profiling a population

Risk profiling and case management Individualised Care plans Telehealth Community Matrons Case Managers – Elder Care Facilitators Intensive support for LRCs Third sector and voluntary organisations Medicines Optimisation?

Limitations of tools Medicines costings are inaccurate Coding errors Rare and spurious conditions Expense and time

Medicines Optimisation in targeted populations In Care Homes 4 or more medicines with renal disease Post discharge Taking high risk medicines Those identified by a risk prediction tool Those with a particular condition Those referred to a service

A vision of care services in 5 years

The House of Care model

Performance Measures A measure to evaluate how well a programme, agency or service system is working. Three questions: How much did we do? (quantity) How well did we do it? (quality) Is anyone better off as a result? (quantity and quality of effect or customer/client outcomes) Performance measures tell us how well service providers are working as opposed to the impact on whole populations

From ends to means ENDS OUTCOMES “A condition of well-being for children, adults, families or communities” PERFORMANCE MEASURES “A measure to evaluate how well a programme, agency or service system is working” MEANS INDICATORS “A measure which helps quantify the achievement of an outcome” Population Accountability Performance Accountability

Further opportunities? More patient contact Links with Community Pharmacies Social Services Intermediate Care Team Hospital discharge pharmacists

Where does Medicines Optimisation fit in?