Optimising integrated care medicines in Wirral
Background
An estimated five per cent of all hospital admissions are related to medication, with half of those being preventable. It has also been suggested that 50 per cent of medication is not taken as directed, leading to waste. Wirral Clinical Commissioning Group (CCG) commissioned us to undertake a 12-month integrated medicines optimisation project to address these issues locally
Action
We undertook a pilot project from July 2017 to July 2018 to identify the benefits of a pharmacist working with the community integrated teams.
We identified 20 GP practices for involvement in the project by using data relating to high rates of unplanned admissions collated by the CCG’s business intelligence team. Patients were targeted if they were:
- aged over 85 with one or more hospital admission;
- taking six or more medications with more than one hospital admission;
- taking 10 or more medications with unplanned hospital admissions; or
- being transferred to care home intermediate bed for assessment.
Other patients referred to the integrated team pharmacist included those who were:
- stockpiling medicines at home
- confused about their medication
- non-compliant
- prone to falls and taking more than four medications
- post-discharge with changes made to medication
- suitable for deprescribing.
Impact
With a total cost of £65,900 for implementing and delivering the service, the return on investment (RoI) was more than 2:1 with respect to annualised cost saving from medicines optimisation interventions only. The total potential cost improvements for the Wirral healthcare system was £488,984, giving an overall maximum RoI in excess of 7:1.
|
Outcome measure |
Outcome |
|
Total potential cost improvement
|
£488,985 |
|
Annualized cost savings due to medicines optimisation (e.g. deprescribing, dose optimisation, switching to cost effective medication) |
£159,925 (p.a.) |
|
Reduction in potential hospital admissions (RiO tool level 3 interventions) |
104 potential hospital admissions avoided in patients >65years 14 potential hospital admissions in patients <65 years Estimated cost avoidance = £329,060 |
|
Total number of medication reviews completed 1 July 2017 - 31 July 2018 |
1459 |
|
Total number of ‘transfer to assess’ patient reviews completed |
85 |
|
Total number of high risk medicine optimised or stopped |
273 |
|
Number of medications stopped or switched due to contra-indications and/or adverse drug reaction |
85 |
The suggestions I am aware of have been very useful. It is particularly good that you have been able to review some of the patients we often don’t see or those for whom we don’t have enough time to review their medication within a consultation.”
Dr K. Grey | West Wirral Group Practice
“Thanks so much for the help with my medicines ordering. I was getting awfully confused with it ‘all over the shop’. I just didn’t realise it would be so simple for you to sort it out for me. You’ve really explained things to me so I can understand what each medicine is for and how they work together.”
Elderly female patient