Supporting medicines adherence developing the pharmacist contribution

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  • A user friendly interface means people are able to navigate around the various components of the programme and see what is coming up and how much is to be completed.
  • The programme itself has expected benefits such as it is interactive with opportunities for the pharmacists to click, watch videos as well as read content. But it also enables them to reflect on their current practice in dealing with people. The techniques are embedded in the videos provided and pharmacists are then able to reflect further on these as examples of both good and poor practice. Critically for busy pharmacists they can complete the package at their own pace, at the office or at home and they can stop and pick up where they left off. Once finished they print off their own certificate of completion. So let’s take a closer look at what they will experience.
  • The learning outcomes are clearly explained and easy to achieve in completing the package
  • A voice over guides the learner through the information throughout the programme.Before viewing the videos, the learner has the opportunity to review the key points with a simple click on each part which again provides a summary in diagram form of the key points to be remembered.
  • Videos embedded into the programme provide a seamless experience for the learner and once they have viewed the demonstration learners are again given an easy to understand diagram of the issue being disucssed – in this case ambivalence.
  • Further on, a video shows a consultation and the learner then has the opportunity to provide feedback on the consultation
  • The learner is able to:Rate how effective the pharmacist established a therapeutic relationship with patient. Add their own comments in the free text box (optional)
  • Supporting medicines adherence developing the pharmacist contribution

    1. 1. Supporting medicines adherence: Developing the pharmacist contribution Graham Davies | Professor of Clinical Pharmacy and Therapeutics King’s College London
    2. 2. ProfessorGraham Davies, Institute of Pharmaceutical Science King’sCollege London
    3. 3.  South London project – supporting patients with diabetes  Supporting community pharmacists to deliver adherence support  Key challenges to future care – the Southwark and Lambeth IntegratedCare initiative  Summary
    4. 4. Richmond 174,400 Wandsworth 269,300 Kingston 150,000 Merton 192,300 Sutton 180,900 Croydon 336,600 Bromley 335, 914 Lewisham 284,746 Lambeth 329,174 Southwark 298,073 Greenwich 262,145 . Bexley 233,33311 2 6 5 9 14 12 3 4 15 5 8 7 17 13 1 10 2 4 5 9 8 6 1 10 7 3 16 2 3 4 5 6 7 8 9 10 1 11 12 13 14 15 16 17 Bethlem Bolingbroke Hospital Epsom Hospital Guy’s Hospital King’s College Hospital Kingston Hospital Lambeth Hospital Maudsley Mayday Hospital Oxleas Queen Mary’s Hospital Royal Marsden – Sutton Hospital South London Healthcare St Helier Hospital St Thomas’ Hospital Tolworth Hospital University Hospital Lewisham 1 Greenwich University 2 King’s College London (The Strand) 3 King’s College London (Waterloo) 4 King’s College London (Guy’s) 5 King’s College London (St Thomas’) 6 King’s College London (Institute of Psychiatry) 7 Kingston University 8 Lambeth College 9 London Southbank University 10 St George’s University Four key priorities: • Mental health • Diabetes • Stroke • Infection
    5. 5.  Estimated that there are 3.1 million people with diabetes in England. 800,000 of these are not diagnosed (1)  By 2020 an estimated 3.8 million adults, or 8.5% of the adult population, will have diabetes and by 2030 this is estimated to rise to 4.6 million or 9.5% (1)  The NHS in England spends more than £2.3 billion a year on inpatient care for people with diabetes.That’s 11% of NHS inpatient care expenditure (2). Length of hospital stay is 2-3 nights longer than those without diabetes.  Anti-diabetes medicines cost the NHS £725 million/year.  30 -50% of medicines prescribed for long-term illnesses not taken as directed  For diabetes, we can estimate at least £200 million/year waste (1) APHO Diabetes Prevalence Model, http://www.yhpho.org.uk/resource/view.aspx?RID=81090. Last updated 28/09/2010 (2) NHS Diabetes report November 2011. www.diabetes.nhs.uk
    6. 6. 0% 10% 20% 30% 40% 50% 60% %obese Schools - % Obese Southwark average London average England average Schools Reducing UnwarrantedVariation Fourfold variation in the rate of hospital admissions for diabetes in London PCTs Fivefold variation inY6 childhood obesity rates across primary schools in Southwark Tenfold national variation in the % of type 2 diabetics receiving all 9 NICE key care processes Threefold variation in uptake of structured education across South London with best at 29%
    7. 7.  Key stakeholders from across south London invited to discuss how community pharmacists could be more specifically involved in supporting people with diabetes.  Participants included representatives from national diabetes organisations, patient representatives, academics, commissioners and healthcare professionals.
    8. 8.  Supporting patients’ use of medicines  Identifying concerns and facilitating goal setting  Screening for undiagnosed diabetes  Risk assessment using trigger drugs  Supporting use of glucose meters and test strips  Communication skills to promote inter- professional working  Signposting  eye and foot checks; access to support groups and structured education (DESMOND)
    9. 9. “…I’ve been going to the same place for the past 3 years and they understand my history and if my medication has run out they will phone me to remind me.” Patient 3 “...I ring up the pharmacist, supplies are getting a bit low, tell them what I want...he will ring the surgery and I will go in about 2 days later and it’s all waiting for me. He will do a delivery service for those who need it.” Patient 14
    10. 10.  Raise awareness of common beliefs about illness and treatment held by patients  Enhance consultation skills  Provide systematic approach  Examples of good behaviours  Develop a proactive versus reactive approach
    11. 11. Endorsed by the Royal Pharmaceutical Society
    12. 12.  Increase awareness about adherence and challenges  Underpinned by evidence:  Perceptions and Practicalities model1  Focus on consultation skills using validated framework (MRCF)2  Highlights patient-centred approach to better understand their medicine-taking behaviour  Demonstrates good consultation behaviours which can lead to behaviour change  Motivational interviewing 1 Horne, R. &Weinman, J. (1999) Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47 (6), 555–567. 2 Abdel-Tawab R et al (2011). Development and validation of the Medication-RelatedConsultation Framework (MRCF). Patient Education and Counseling 83 (3): 451-457.
    13. 13. Interactive Videos demonstrate different levels of effective practice Work at your own pace Reflect on your own practice Techniques explained in full Rating exercises to reflect on level of practice Features & Benefits
    14. 14. PRE-MODULE ASSESSMENT (Clinical Knowledge) PART 1: Assessing and addressing adherence in diabetes PART 2: Identifying and consulting with non-adherent patients with diabetes PART 3: Using consultation skills to identify and address patient non-adherence in diabetes POST-MODULE ASSESSMENT & REFLECTIVE EXERCISES
    15. 15. Low concerns High concerns High necessityLow necessity Sceptical AcceptingIndifferent Ambivalent Mann et al. (2009)
    16. 16. No of Conditions per patient 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% People(%) Age Groups (Years) Morbidity (number of LTCs) by Age Group 0 1 2 3 4 5 6 7 8+
    17. 17.  Co-morbidities with ageing  Engagement of different health care professionals  Silo approaches  Poor transfer of information  Lack of consistency in messages  Medicines adherence  Not routinely assessed or documented  Agreed plan or intervention not documented  New Medicines Service and MUR a start
    18. 18. Citizens will feel that their health is also their responsibility and will be supported in self management by building community assets, capabilities and skills. We will provide the right care in the right place, at the right time, reliably and proactively by the professional(s), peer support workers or volunteers most suitable to provide care. Ensure we are treating the whole person with integrated care centred around empowered individuals. Ensure professionals are best able to deliver this new approach, ensure better professional lives for the staff we are working with. This requires behaviour change by all professionals, citizens and communities. 1. 2. 3. 4. 5.
    19. 19. We need to shift the LTC care paradigm from people being dependent recipients of care to enabling and supporting people with LTCs to live independently and optimally with their condition. Doing more of the same better will not be enough Must do better: • LTCs are under-diagnosed • Too many people with LTCs die prematurely • QOF scores for LTC management are well below London average in 7 of 17 LTC diagnoses The ‘Scissors of Doom’ - Growing demand with less funding • Population in S&L expected to grow by 18% in next 10 years • Aging population • People live longer with LTCs • Funding for NHS, Public Health and Social Services is falling well behind growth in demand
    20. 20. Undertaking healthy behaviours • Not smoking, Exercising, Healthy eating, Drinking alcohol in moderation Keeping home environment safe • Impaired mobility and physical ability to take care of all activities of daily living • Cognitive decline with impaired ability to run a household independently • Epilepsy with frequent seizures and risk of injury Optimising medicines use • Taking medications as prescribed or knowing how to take PRN medications Detecting and addressing risks early • Detecting people at risk and stratification • Early effective interventions • Care management
    21. 21.  Scoping the key issues, problems and successes  Developed medication adherence screener  Piloted in hepatitis C out-patient clinic  Adoption byThrombosis Centre (KCH) - focus on transfer of warfarin patients to NOAC (time in range <50%)  CCG backing to use screener in GP cluster.
    22. 22. Pilot in 40 patients – over 20% admitted to missed doses in week before clinic The majority of patients (70%) had concerns about their medicines Frequency (%) Possible side effects 23 (62) How the medicines may damage my body in the long term 9 (24) Taking too many medicines 9 (24) Whether the medicines will be of any help 4 (11) Whether their effectiveness will wear off over time 4 (11)
    23. 23. • Preliminary results suggest that the screener can be integrated into routine care to identify non-adherence • Non-adherence appears to be associated with: • Low motivation (as conceptualised by the Modified Morisky i.e. forgetfulness and carelessness) • Perceptual barriers (only took their medicine when they felt the need) • Practical barriers (poor planning of medicine-taking behaviour ) • Used by MDT to target inform consultation during clinic visit
    24. 24.  Capture medicines adherence data routinely and make available to:  Aid provision of consistent messages  Facilitate patient self-management  Training for all HCPs is key  Opportunity within Lambeth and Southwark to design and test a system for LTC which draws on expertise of pharmacists  Need to measure impact of approach on health care outcomes/utilisation/satisfaction
    25. 25. ProfessorGraham Davies, Institute of Pharmaceutical Science King’sCollege London

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