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

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

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

4. 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

5. 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?

6. 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

7. 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

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

9. 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 residents
Age Ave 85.5y (Range 56 to 104)
Sex (77.7%) Female

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

11. Deprescribing

12. 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

13. 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

14. 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

15. 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