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Medicines optimisation – a research pharmacist’s perspective

Medicines optimisation – a research pharmacist’s perspective. Dr David Alldred Senior Lecturer in Pharmacy Practice. Presentation outline. Medicines optimisation Medicines optimisation research for older people Outcome measures Impact Future research. Medicines optimisation – 4 principles.

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Medicines optimisation – a research pharmacist’s perspective

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  1. Medicines optimisation – a research pharmacist’s perspective Dr David Alldred Senior Lecturer in Pharmacy Practice Bradford School of Pharmacy

  2. Presentation outline • Medicines optimisation • Medicines optimisation research for older people • Outcome measures • Impact • Future research Bradford School of Pharmacy

  3. Medicines optimisation – 4 principles • Understanding patient experience • Evidence-based choice of medicines • Ensuring safe use of medicines • Making medicines optimisation routine practice Patient-centred approach central to medicines optimisation Measurement and monitoring Improving patient outcomes Bradford School of Pharmacy

  4. Bradford School of Pharmacy

  5. Clinical medication review • RCT in 661 care home residents • Clinical medication review by a single pharmacist • Significant reduction in falls RR 0.59 (95% CI 0.49-0.7) • More drug changes in intervention group • No effect on other outcomes (hospitalisations, mortality) Bradford School of Pharmacy

  6. Care Homes’ Use of Medicines Study (CHUMS) Mean age 85, on mean of 8 meds 7 out of 10 residents were exposed to at least one medication error (mean of 1.9 errors/resident) • Prescribing errors 8.3% of medicines (39% of residents) • Monitoring errors 14.7% of medicines (18% of residents) • Dispensing errors 9.8% of medicines (37% of residents) • Administration errors 8.4% (22% of residents) Barber et al 2009

  7. Sensitivities • 121 residents in 31 homes • 31 (26%) had ≥1 sensitivity, 48 in total • No. of sensitivities recorded: GP 35 (73%) Care home records 29 (60%) Medicines administration record 3 (6%) • Only 2 sensitivities documented on all three records

  8. Sensitivities Bradford School of Pharmacy

  9. Cochrane summary • 8 RCTs • 7653 residents in 262 care homes in 6 countries • 6 cluster-RCT, 2 patient-RCT • Diverse, multifaceted interventions (medication review, case-conferencing, education, clinical decision support) Bradford School of Pharmacy

  10. Cochrane summary • Heterogeneity • No evidence of an effect on adverse drug events, hospital admissions and mortality • No studies measured quality-of-life • Medication-related problems resolved and medication appropriateness improved Bradford School of Pharmacy

  11. Outcome measures – What? How? When? • No. of medicines • Interventions • Prescribing appropriateness • Medication errors • Medicine-related problems • Adverse drug reactions • Hospital admissions • GP consultations • Falls • Adherence • Patient experience • Biochemical markers • Symptom control • Cognitive assessment • Assessment of ADL • Mortality • Quality-of-life • Cost effectiveness Bradford School of Pharmacy

  12. Collaboration • Interdisciplinary • Multi-professional • Academics • Patients and carers • Patient and carer organisations • Practitioners

  13. Collaboration

  14. Impact Bradford School of Pharmacy

  15. Impact • Raised profile • Commissioning of local pharmacy-led services • Commissioning of other services to improve medicines use in care homes • Guidelines (RPS, NICE) • Care homes projects • CQC Bradford School of Pharmacy

  16. Medicines safety in care homes

  17. NICE Managing Medicines in Care Homes

  18. Care Home Independent Pharmacist Prescribing Service (CHIPPS) NIHR programme grant £2m/5y • WP1 Literature review and stakeholder consultation (service specification) • WP2 Outcome measures • WP3 Health economics • WP4 IP training package • WP5 Feasibility study • WP6 Cluster-RCT Bradford School of Pharmacy

  19. Improving the safety and continuity of medicines management at caretransitions (ISCOMAT) • WP1 - Mapping and evaluation of the cardiology medicines management transitions pathway • WP2 Developing a patient-centred care pathway and communications package • WP3 Feasibility Study • Work Package 4 Evaluation of intervention effects and cost-effectiveness (cluster-RCT) Bradford School of Pharmacy

  20. Key points • Patient-centred approach • Patient-oriented outcomes • Multi/inter-disciplinary • Collaboration • Well-designed, theoretically-based interventions • Impact Bradford School of Pharmacy

  21. Selected references Alldred DP et al 2013. Interventions to optimise prescribing for older people in care homes. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD009095. DOI: 10.1002/14651858.CD009095.pub2. Alldred et al 2011. The influence of formulation and medicine delivery system on medication administration errors in care homes for older people. BMJ QualSafDOI: 10.1136/bmjqs.2010.046318 Alldred et al 2010. The recording of drug sensitivities for older people living in care homes. Br J ClinPharmacol69:553-557 Barber ND et al 2009. The Care Homes’ Use of Medicines Study: prevalence, causes and potential harm of medication errors in care homes for older people. QualSaf Health Care18, pp.341-6. Available athttp://qshc.bmj.com/content/18/5/341.abstract Zermansky AG et al, 2006. Clinical medication review by a pharmacist of elderly people living in care homes - Randomised controlled trial. Age Ageing. 35(6)pp 586-591. Bradford School of Pharmacy

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