Medicines Optimisation

Between 30% and 50% of the 15 million patients living with a long term condition are estimated not to take medicines as expected.

The AHSN NENC Medicines Optimisation programme, which was first launched in 2013, aims to ensure patients receive support to take their medicines both in the community and after leaving hospital. It is dedicated to the NHS triple aim of improving patient outcomes, maintaining quality and safety of care and ensuring value for money.

The initial phase of the programme has focussed on a number of projects aimed at supporting patients taking medicines in a variety of settings, including

  • Clinical Handover – Each acute hospital in the region has access to refer patients on discharge to their chosen local community pharmacy for continued support with their medicines using existing NHS services. Early indicators show positive benefits. Future plans are to explore the use of electronic referrals with specific clinical conditions. A BMJ open paper has been published which indicates that patients who attend follow appointments with community pharmacists are less likely to be readmitted to hospital
  • Supporting Vulnerable Adults – A scoping exercise was undertaken across the region which has shown a high level of variation in pharmacist led medication reviews and varying amounts of resources dedicated to this work across the CCGs. The purpose of the exercise was to highlight the geographical variation of a service that has been proven to be beneficial in both patient health outcomes and financially
  • A Person Centred Approach to Medicines Adherence – developing a consistent approach to assessing the type of compliance support required.

Future Plans

In June 2018 the AHSN NENC joined forces with NHS North of England Commissioning Support (NECS) to re-launch the programme. With NECS taking an enhanced leadership role, the initiative will benefit from its engaged network of local, regional and national Medicines Optimisation groups including local primary care prescribing networks, Senior Pharmacy Managers Network, pharmaceutical networks and various advisory groups.

Initially the programme will focus on supporting national initiatives across 4 key areas:

  • Roll out of PINCER Pharmacist-led information technology intervention for reducing clinically important errors in general practice prescribing (PINCER)
  • Identifying and addressing inappropriate polypharmacy
  • Improving clinical handover to community pharmacy
  • Engaging patients and the public in Medicines Optimisation work.

Polypharmacy

We recently announced a project call for polypharmacy projects, the following projects were successful:

De-prescribing in Primary Care Getting Started

Despite a wide variety of validated de-prescribing tools being available for use in clinical practice, active de-prescribing in primary care is generally accepted to be low. Feedback from clinicians working in this setting expressed uncertainty about where to start with developing their de-prescribing practice.

The project aimed to work with clinicians across primary and secondary care to co-design tools to support de-prescribing within general practices.

A full report of the project can be downloaded (link provided)

Download De-prescribing in Primary Care Report

The next steps are to develop the de-prescribing brand using a final process of live testing before wider roll out.

 

Polypharmacy Education in DDES & N. Durham CCGs

North Durham & DDES Joint M.O. Team, Rachel Berry

Commencing 1st April 2019 – 31st Jan 2020

The Joint MO Team is proposing to develop and deliver a programme of education to upskill primary care prescribers and practice based pharmacists regarding de-prescribing in key therapeutic areas (cardiovascular, falls, pain, kidneys).

**Final project reporting has been delayed due to the COVID-19 pandemic crisis**

 

What is the impact of educational interventions on the prescribing of hypnotics at NTW FT?

The aim of the project was to create multi-professional, system-wide educational resources, which can be used as interventions to improve knowledge of sleep and sleep disorder management.

Successful project outcomes include:

  • 41% reduction in the number of administrations of hypnotics across the intervention period
  • 29% reduction in the number of patients with active hypnotic prescriptions
  • Identification of significant areas for improvement, both locally and nationally
  • Significant cultural change in prescribing practices, including a more holistic patient assessment and investigation, and wider use of appropriate non-pharmacological interventions.
  • Three supportive interventions have been produced: a poster, a video and a handbook (links provided)

This work also feeds into the wider Trust Sleep Well Programme, which aims to implement other holistic interventions such as lighting and estates.

Download the Sleep Handbook

Download Hypnotics Poster

 

Reducing antibiotic prescribing through community pharmacy provision

CNE Local Professional Network, Mike Maguire

To test the feasibility of reducing antibiotic prescribing in general practice using the local community pharmacies. Practice receptionists will refer patients who request antibiotics by telephone to community pharmacists for CRP testing, the results of which will inform the consideration of treatment.

View case study

**Final project reporting has been delayed due to the COVID-19 pandemic crisis**

 

A ‘World Cafe’ approach to address the inappropriate prescribing of intravenous antibiotics in futile clinical scenarios

Northumbria Healthcare Trust & Newcastle University, Tanya Miah

Commencing 1st May 2019 – 30 April 2020

Northumbria Healthcare NHS Trust and the School of Pharmacy at Newcastle University researchers will work together to develop, implement and test ‘Antibiotic Cafes’ with the aim of discussing key clinical issues relating to the prescribing of IVA at the end of life. Healthcare professionals (doctors, nurses, pharmacists and HCPs with an interest in antimicrobial stewardship) and students will be invited to attend the ‘Antibiotic Cafe’.

**Final project reporting has been delayed due to the COVID-19 pandemic crisis**

 

Optimising the management of COPD exacerbations in primary care

North West, North Tyneside Primary Care Network and NHS Business Services Authority. Paul Davies

Commencing 1st October 2019 – 31st March 2020

Despite the availability of local and national guidance regarding the management of COPD exacerbations in primary care, prescribing patterns vary between practices.

Practices with high prescribing rates of rescue medication for COPD will be identified via the NHS BSA respiratory dashboard; they will then be offered individualised support using Quality Improvement methodology.

There is further useful information on our respiratory page.

**Final project reporting has been delayed due to the COVID-19 pandemic crisis**

 

If you have any queries regarding Polypharmacy please contact sue.hart@ahsn-nenc.org.uk

To find out more about the overall Medicines Optimisation programme please contact Janette Stephenson Janette.Stephenson@ahsn-nenc.org.uk