Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
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Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson

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Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson ...

Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson
Medicines Management Pharmacist (NHS Hampshire)
Independent Prescriber (Victoria Practice, Aldershot)
Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013,
Guoman Tower Hotel, London
How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

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    Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson Breakout 4. 2 Benefits of implementing medicines optimisation in a COPD and asthma clinic - Clare Watson Document Transcript

    • Benefits of Implementing Medicines Optimisation in a COPD and Asthma Clinic Clare Watson Medicines Management Pharmacist (NHS Hampshire) Independent Prescriber (Victoria Practice, Aldershot)The Victoria practice participated in aNational Improvement programme to improvemanagement of patients with COPD andAsthma, by providing a patient centredservice focusing on Use of Motivational Interviewing techniques Adherence Inhaler technique Implementing Evidence based cost effective prescribing in line with current national guidance eg. Nice, BTS/SIGN Regular patient review and follow up Reducing waste 1
    • What is Medicines Optimisation?Medicines optimisation is a more patient-focusedapproach to getting the best from medicines.Focused on the patient and their experience, it canhelp more patients take their medicines correctly,reduce waste of medicines, avoid patients takingunnecessary medicines and improve medicinessafety. Ultimately it can help encourage patients totake more ownership of their treatment.Royal Pharmaceutical Society – Good Practice Guidance forHealthcare Professionals Sept 2012Why Medicines Optimisation? Suboptimal prescribing and/or patient adherence affects patients’ ability to self manage, use of primary care, admissions, A&E attendance and medicines cost Current cost of all asthma and COPD medication: £1.17billion pa Choice and cost of medicines How do patients really use medicines? 2
    • BMJ October 2012…. “45 million prescriptions for respiratory inhalers were dispensed in 2011 in England alone—at a cost of £900 million to the NHS—everyone needs to be more clued up on correct inhaler technique to make sure these drugs work well for patients and offer the best value for money for the NHS”Designing and commissioning servicesfor adults with asthma: A good practiceguide. PCC 2012http://www.pcc.nhs.uk/asthma-guide Many patients do not lead lives free of symptoms and this is despite the availability of well-constructed guidelines and good medicines When patients do take their medication, many do it incorrectly, which will have an impact on the cost of treatment and lead to suboptimal outcomes 3
    • How did we know if we had made animprovement? Indicated by cost of respiratory prescribing, medicines mix, admissions and patient CAT score / ACT score before and after the intervention CAT: COPD assessment test: www.catestonline.co.uk ACT: Asthma control test: www.asthmacontroltest.com Context Practice list size: 8476 5 partners (4.5 whole time equivalents) 135 COPD patients 378 Asthma patients Annual reviews offered scope to address medicines use and optimisation Pharmacist led Asthma & COPD clinic (Independent prescriber and Medicines Management Pharmacist, COPD Diploma, Clinical Diploma, Community pharmacy background 4
    • Approach 1 x 5 hour session per week 30 minute appointments Understanding the patient’s attitude to and actual use of medication Encouraging realistic goal setting and behaviour change Using technical knowledge to optimise prescribing (clinical benefit/cost effectiveness)Patient reviews Review compliance, exacerbations, control and medicines ordering over last 12 months Patient consultation incorporating:  Understanding current attitudes & motivation  Good things/Not so good things – decisional balance  Eliciting self sufficiency & patient responsibility  Optimisation of treatment Follow up 5
    • Understanding current attitudes andmotivation using open questions Tell me some more about that What are your thoughts about…? In what ways does that concern you? Describe what it’s like when? How do you feel about….? Tell me what you like about X Tell me some of the things you don’t like about XGoal Setting Where does this leave you? What’s your plan? Given all we’ve talked about today, where would you like to go from here? What do you want to do next? What are the difficulties/benefits of taking your medicine? 6
    • CommitmentOn a scale of 0 to 10 (where 0 = not at all and 10 = very much): How much do you want to start/continue this treatment? How important is it to you to start/continue this treatment? How ready do you feel you are to start/continue this treatment? How much better do you think your life would be if you start/continue this treatment?Wrapping Up How confident do you feel that you will be able to do this? One a scale of one to 10, how confident do you feel? If patient is negative, ask how can you get it up to an 8? Confidence building: Why 7 and not 5? In a month’s time, what is going to be different now that you are taking your medicines? If patient is negative say, “Some people find that…..” If there is no response say, “So nothing is going to change at all?” 7
    • Availability Is the patient on the “right” treatment (medication and device) for their needs? Is it a clinically effective choice? Is it a cost effective choice? Cost comparison tables available on the website belowhttp://www.nyrdtc.nhs.uk/Services/presc_supp/presc_supp.htmlEvidence based? Cost effective? Right choice of medication for condition and severity of disease? Able to use it? Cost effective choice? Examples:  Adding on an aerochamber®  to MDI device  Adding LAMA / LABA  Substituting Seretide Acculaher® for Evohaler ®  Smoking cessation / pulmonary rehabilitation 8
    • Knowledge  Inhaler technique – maintaining own skills as well as checking others  In-Check Dial to achieve optimal inspiratory flow (http://www.clement-clarke.com/products/in-check-dial)  2Tone device for MDI users (Now replaced by In- Check Flo-Tone http://www.flo-tone.com)  Follow up calls or appointments to check progress & understanding  New medicines not added to repeats until impact assessed Victoria Practice Prescribing cost 16000 14000 12000 10000 8000£ 6000 4000 2000 0 Jac- 0 7 Jac- 0 8 Jac- 0 9 Jac- 1 0 AJul-0 7 M b-0 8 Au l-0 8 M b-0 9 Auul-0 9 M b-1 0 A u l- 0 M b-1 1 l-1 1 A ar- 08 M pr- 08 A ar- 09 M pr- 09 A ar- 10 M pr- 10 A ar- 11 M pr- 11 Sug- 07 Seg- 08 Seg- 09 Seg- 10 1 ep 7 t- 0 7 Fen-0 7 Ocp- 08 No t- 8 Fen-0 8 Ocp- 09 No t- 9 Fen-0 9 Ocp- 10 No t- 0 Fen-1 0 Jay-07 Juy-08 Juy-09 Juy-10 ay 1 un 7 Ju -08 J n- 9 Ju -10 Ju -11 De v- 7 De v-08 De v-09 De v-10 1 0 0 1 Oc - 0 M pr- 0 a 0 a 0 a 1 Ju -1 - n n n No A £ prescribing cost The Mean (Average) Upper Control Limit Lower Control Limit 9
    • Change in consecutive CAT score by patient 35 30 25CAT score 20 Original CAT score 15 Second CAT score 10 5 0 1 2 3 4 5 6 7 8 9 10 Patient Key Learning  30 minute appointments allow time to establish rapport with the patient and understand issues affecting adherence  Follow up reinforces patient understanding and behaviour  Telephone calls in advance can reduce DNAs.  Synchronise repeats where possible to reduce waste, patient inconvenience and surgery work load  Relationships are key  Pharmacist skills can provide a cost effective approach to improving medicines optimisation in the management of any long term condition and enhance the skill mix in the practice team 10
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