How Pharmaceutical Advisers Can Ensure Quality and Effectiveness at the Interfaces - PowerPoint PPT Presentation

Loading...

PPT – How Pharmaceutical Advisers Can Ensure Quality and Effectiveness at the Interfaces PowerPoint presentation | free to download - id: f6214-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

How Pharmaceutical Advisers Can Ensure Quality and Effectiveness at the Interfaces

Description:

What are the medicines and pharmacy issues? ... (ref: Bandolier Extra, June 2002, Adverse Drug Reactions in Hospital Patients: A ... – PowerPoint PPT presentation

Number of Views:24
Avg rating:3.0/5.0
Slides: 33
Provided by: cart66
Learn more at: http://www.healthlinks-events.co.uk
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: How Pharmaceutical Advisers Can Ensure Quality and Effectiveness at the Interfaces


1
How Pharmaceutical Advisers Can Ensure Quality
and Effectiveness at the Interfaces
  • Sue Carter MRPharmS
  • Head of Prescribing Pharmacy,
  • Adur, Arun Worthing tPCT
  • And Co-Founder,
  • Primary Care Pharmacists Association

2
Overview
  • Interfaces where are they?
  • How are the interfaces shifting?
  • What are the medicines and pharmacy issues?
  • How can those issues be addressed by primary care
    pharmacists?
  • Some points to ponder

3
Interfaces Where (and What) Are They?
  • Classical description when a patient goes into
    or comes out of NHS hospital elective and
    non-elective
  • . But also out-patient activity and out-reach
  • . And also social care, intermediate care,
    self-care
  • . And also out-of-hours services
  • . And also private providers
  • Communication
  • Pharmacists ? GPs ? patients ? secondary care ?
    social care ? community healthcare ? health
    service managers

4
Interface
  • Discharge admission
  • Communication
  • Local guidelines
  • Integrated medicines review as part of seamless
    patient care
  • GP medical records
  • Ensuring quality of care and managing risk
  • Shared care
  • Shared care guidelines
  • Prescribing responsibility
  • Monitoring
  • Service redesign
  • Policies DTC, APC,
  • Formulary
  • Service level agreements

5
Policy Changes the Road Ahead
  • Patient choice plurality
  • Chronic disease management managed care
  • Primary care contracting innovation
  • Payment by results tariffs foundation trusts
  • Service modernisation secondary to community
    shift, tier 2 services,
  • Non-medical prescribing
  • Practice based commissioning
  • Demand management resource management

6
Intermediate care
Social care
Home Self Care
GP Surgery
Admission Discharge
Tertiary care
Secondary care
Primary Care pharmacy
Hospital Pharmacy
Community Pharmacy
7
Intermediate care
Social care
INDEPENDENT SECTOR
Home Self Care
GP Surgery
PLURALITY
Admission Discharge
Tertiary care
CHOICE
Secondary care
Primary Care pharmacy
Hospital Pharmacy
Community Pharmacy
8
(No Transcript)
9
Intermediate care
Social care
Home Self Care
GP Surgery
Admission Discharge
Primary care pharmacy
Hospital Pharmacy
Community Pharmacy
10
Where Do Medicines Pharmacy Fit?
  • 4 in 5 over 75s take at least one medicine and
    36 of them take 4 or more
  • Half of people with long term conditions fail to
    take medicines properly
  • 5 to 17 of hospital admissions may be due to
    older peoples problems with medicines
  • . And while in hospital 6 to 17 will experience
    an adverse drug reaction

11
Where Do Medicines Pharmacy Fit?
  • USA evidence
  • Estimated 44k to 98k deaths per year due to
    medication errors (including adverse drug events)
  • 6th most common cause of death in the USA (higher
    than RTAs, suicide, homicide and AIDS)
  • Costs estimated at 76.6 billion dollars per annum
    in the USA
  • (Ref JAMA 2002 9479-490)
  • USA long term condition managed care outcomes
  • Decreased use of medicines with benefits to
    health
  • Reduced medicines-related adverse events
  • 39 of patients incr. compliance with medication

12
Where Do Medicines Pharmacy Fit?
  • UK - Importance of ADRs
  • Estimated to take up 4 out of 100 hospital bed
    days
  • Estimated 15 to 20 x 400 bed hospital equivalents
  • Annual UK cost 380 million per year
  • One in 10 of all NHS bed days are taken up by
    consequences of ADR or hospital-acquired
    infection
  • (ref Bandolier Extra, June 2002, Adverse Drug
    Reactions in Hospital Patients A systematic
    review of the prospective and retrospective
    studies. Whiffen P, Gill M, Edwards J, Moore A.
    www.ebandolier.com)
  • Has led to UK focus on managed care, community
    matrons, transforming long term care programmes,
    etc
  • Medicines management has huge, as yet largely
    undeveloped, potential to ensure quality and
    effectiveness at new and existing interfaces
  • Pharmacists are the experts in all aspects of
    medicines use

13
Medicines Management
  • Medicines management is a broad term which
    encompasses every aspect of use of medicines at
    both organisational and individual patient level

14
Medicines Management
  • Service improvement demand management
  • Policy, strategy and performance management
  • Budgets, incentives monitoring
  • Statutory responsibilities legal framework
  • Workforce planning skillmix
  • Rational prescribing
  • Clinical governance
  • Dispensing
  • Access to medicines
  • Patient-centred medication review
  • Concordance, compliance patient partnership /
    support

15
Evolved Approach to Medicines
  • Proactive, patient-centred and systematic
    approach to medicines
  • Patient partnership for improved self-care
  • Stratifying patient population to identify high
    risk
  • Individualised care plan to prevent adverse event
    improve outcomes, based on need, preference
    choice
  • Pharmaceutical care
  • Service redesign
  • Opportunities in new contracts

16
Medicines Management Ensuring Quality and
Effectiveness
  • Make sure it is -
  • Safe
  • Effective
  • Efficient
  • Systematic
  • Needs based
  • Patient centred
  • Accessible
  • Multidisciplinary
  • Integrated
  • Sustainable
  • Supported with clinical leadership

17
Safe Guidelines Protocols
  • Joint formularies
  • Practice formularies
  • Reviews and advice
  • Formal local guidelines
  • Development
  • Consultation
  • Implementation
  • Monitoring
  • Audit
  • Shared care guidelines
  • Prescribing by new groups of professionals
  • NHS increasingly protocol / guideline driven
  • NICE guidance and guidelines
  • NSF standards
  • Prodigy
  • NHS direct
  • Local health economies
  • Performance management - healthcare commission

18
Effective
  • Evidence based practice
  • Only part of decision making
  • Monitor outcomes
  • Admissions
  • Quality and outcome framework
  • Spend or prescribing patterns
  • Interventions
  • Pharmaceutical care record outcomes!

19
Efficient
  • Target the right service to those that need it
    most
  • Avoid unnecessary duplication
  • Integrate complementary services across a health
    economy for maximum effect
  • Develop IT systems
  • Take a patient focussed approach
  • Elderly diabetic asthmatics develop CHD!

20
Targeted Medicines Management
21
Systematic
  • Practitioner
  • Assess, plan, evaluate
  • Ongoing not just a single point review
  • Identify problems, implement plan to avoid or
    monitor for problems
  • Set therapeutic goals for each drug
  • Pharmacist (or practitioner) takes
    responsibility for outcomes
  • Commissioner
  • Strategy
  • Equity of access
  • Monitoring
  • Clinical governance
  • Resources
  • Workforce development

22
Needs Based
  • Medicines are unique as a clinical intervention
  • Vast majority are self (or carer) administered
  • .And so factors other than disease prevalence
    dictate the need for care
  • Prioritisation should be based on agreed values
  • Stratified approach
  • Patient and public involvement
  • Equity, fairness, effectiveness, cost
  • Health needs assessments
  • Health equity audit
  • Systematic prioritisation

23
Patient Partnership in Medicine Taking
  • Empowering patients to take an active role in
    managing their own care.
  • Prescribing needs to be based on an agreement
    between the patient and the health care
    professional.
  • Pharmacists can help in this process
  • educating about treatments and options
  • interpreting and explaining risks and benefits
  • Proactive support resource to patients

24
Accessible - Services
  • Pharmaceutical services distribution
  • Contract regulation reform
  • Competition choice
  • Workforce
  • Commercial pressure
  • Professional pressure
  • Local pharmaceutical services
  • Resources
  • Out of hours
  • Pharmacists and NHS direct
  • Dispensing out-of-hours
  • Access to pharmaceutical care
  • Supporting self-care
  • Minor ailments

25
Accessible - Medicines
  • Patient group directions
  • POM to P
  • P to GSL?
  • Walk-in centres
  • One-stop primary care centres
  • Health centre pharmacies v. High street
  • Electronic prescribing e-pharmacy
  • Non-medical prescribing
  • Supporting self-care

26
Multidisciplinary
  • Not just about pharmacists
  • The agenda is huge
  • And so are opportunities for those who are
    ready
  • Other staff are better placed to provide many
    aspects of medicines management
  • And are trying to do it at the moment!
  • And are less expensive!
  • But maybe have different skill sets

27
Integrated
  • Consistent approach driven by policy, protocol,
    standards etc
  • Responsibilities clearly defined
  • And accountability (duty of care?)
  • Communication should be effective, efficient and
    responsive but not as easy as it seems!
  • Single assessment develop national SAP for
    medicines?

28
Sustainable
  • Longer term finances avoid pilot syndrome
  • Demonstrate benefits
  • Dont overload already hard-pressed professionals
  • Identify champions
  • Define roles and build relationships

29
Clinical Leadership
  • From all professions involved including
    pharmacists
  • Leaders provide knowledge and expertise for
    service / protocol development
  • Leaders educate
  • Mentoring or shadowing (accompanied visits)
  • Leaders could take on difficult bits
  • Provide ad-hoc advice
  • General encouragement

30
How Are Primary Care Pharmacists Dealing With the
Agenda?
  • Practice, locality commissioning board, (new) PCT
    levels
  • All have operational and strategic need for
    primary care pharmacists
  • Additional statutory roles at PCT level

31
Primary Care Trust
  • Fewer, larger PCTs
  • PCT-wide cross-health economy engagement
  • Co-ordination of local health economy
    medicine-related policies
  • Performance Management
  • Interface medicines management
  • Primary care contracting
  • Procurement initiatives
  • Shared care
  • Influencing clinical practice
  • Workforce development
  • Policy development implementation
  • Statutory roles
  • Local delivery plan / priorities planning /
    horizon scanning

32
Locality Commissioning Board
  • Audit Support
  • E.g. NSAIDs, Asthma, Statins,
  • Newsletter
  • Local health economy formulary development
    support
  • Proactive and reactive advice
  • Local interface issues
  • Commissioning medicines issues
  • Service redesign secondary to primary care
    shift
  • Demand management
  • Performance management
  • Repeat Prescribing Review
  • Practice prescribing analysis

33
GP Practice
  • nGMS general involvement
  • Input to QOF and assessments
  • Practice visits 3 agreed action points
  • Many medicines issues
  • Repeat Prescribing other practice systems
  • Provision of patient centred medicines services
  • Practice prescribing analysis
  • Audit Support
  • Internal practice formulary development support
  • Proactive and reactive advice
  • Interface issues

34
Targeted Medicines Management
  • Level 1 population management
  • Supporting self-care
  • Level 2 care management
  • Disease specific interventions for at-risk groups
  • Supporting patients to optimise medicines use
  • Pharmacists with special interest - e.g. as
    disease-specific care managers
  • Level 3 case management
  • E.g. Targeted medicines support at discharge
  • Proactive pharmaceutical care

35
The New Pharmacy Contract Major Themes
  1. Support for self-care
  2. Management of long-term conditions (CDM)
  3. Public Health health promotion plus

36
Strategic Direction
  • Investment to help older people keep healthier at
    home for longer
  • Intensive case management - Evercare
  • CDM - better, stratified care for people with
    long term illness care closer to patient
  • Developing services in community primary care
    settings secondary to primary shift
  • New organisational systems, structures and
    processes clinical governance risk management
  • Multidisciplinary focus

37
Some Points to Ponder ...
  • How will future primary care led self-care,
    disease management and medicines management
    initiatives impact on pharmacy workforce and
    workload?
  • Can better use of skillmix make enough
    difference?
  • Will the forthcoming white paper take some of
    these issues on?
  • Can quality and effectiveness at interfaces be
    ensured in an NHS with constantly shifting
    structures, rules and personnel?
About PowerShow.com