Arden & GEM’s medicines optimisation team was commissioned by Derbyshire Dales Primary Care Network (PCN) to provide a team of clinical pharmacists to deliver consistent and effective medication reviews for patients across their practices.
Over three months, more than 500 patients were reviewed using a risk stratification approach. In this short period of time over 1,200 quality interventions were identified to keep patients safe, optimise use of medicines, achieve cost savings, and avoid further appointments and admissions.
The project also provided the PCN with the workforce resilience and expertise to achieve Direct Enhanced Service (DES) requirements while freeing up internal resource to deliver the COVID vaccination programme.
The challenge
Derbyshire Dales Primary Care Network covers 13 practices and 81,000 patients in a largely rural area of Derbyshire which takes in the Peak District. With a large number of elderly patients – on multiple medications – living in their own homes, Arden & GEM’s medicines optimisation team was commissioned by the PCN to explore how the CSU’s clinical pharmacists could provide a valuable service to member practices under funding within the Network Contract DES.
Given the PCN’s patient profile, medication reviews for elderly residents on polypharmacy was agreed as the priority area for support, particularly given the challenges networks have in delivering this area of work alongside the COVID-19 vaccination programme.
Regular medication reviews are vital in ensuring that patients are safe, patients are using their medicines correctly and that their medicines are working for them.
Our approach
In order to mobilise the service efficiently, in December 2020, Arden & GEM’s team of clinical pharmacists worked in partnership with GP practice teams to agree a delivery model, workplan and method for recording interventions and benefits.
Clinical pharmacists were also matched with specific neighbourhoods so that strong working relationships could be made with individual practices. Each neighbourhood was also assigned a pharmacist with specialist training in structured medication reviews.
Identifying patients
Two concurrent models of identifying patients were used, depending upon the needs of the practice. For some, patients were identified and appointments booked by the practice, while for others the clinical pharmacist managed this process on the practice’s behalf.
Both models used a risk stratification approach to prioritise those patients at greater risk of having an overdue medication review with a focus on high risk medicines, polypharmacy (patients taking 10 or more medicines) and age.
Undertaking reviews
A team of experienced clinical pharmacists provided level 3 and level 4 medication reviews. These take place directly with the patient, to deliver the greatest improvement in safety, outcomes and medicines use while being patient centred.
Review appointments lasted 30 minutes and, due to the need to keep patients safe during the pandemic, took place by telephone. Clinical pharmacists used their consultation and questioning skills to ensure the remote delivery model was highly effective.
Quality interventions
Over a three-month period 513 patients were reviewed, resulting in a total of 1,211 interventions. Interventions included providing advice, requesting drug monitoring tests, reducing inappropriate polypharmacy and referrals to social prescribers.
For many of the patients being reviewed, this was their first direct contact with a healthcare professional in almost 12 months. This enabled the team to pick up on additional concerns relating to isolation, anxiety and mental health issues and arrange appropriate action to be taken, such as organising multidisciplinary team meetings.
All reviews and interventions were recorded on the CSU’s bespoke recording tool which measured the impact and the outcomes that the clinical pharmacist team achieved across the PCN.
The outcomes
This innovative and novel way of working has led to a number of positive impacts for both patients and practices in Derbyshire Dales:
- A significant number of interventions were made to keep patients safe
- A patient centred approach was taken which has delivered a positive patient experience
- PCNs have been supported with appropriate capability and capacity to achieve their DES requirements.
While the focus of the project was on patient safety and outcomes, the medication interventions have also led to:
- annualised drug savings of over £5k
- an avoidance of 42 GP appointments
- an avoidance of 1.5 hospital admissions.
Patient centred approach
To capture the views and experiences of patients involved in the review process, an anonymous telephone survey was undertaken with patients chosen at random. The survey found that:
- 100% of patients thought the clinical pharmacists had explained everything clearly during the review and that they would be happy to have their next medication review with the clinical pharmacist
- 45% of patients agreed that their understanding of their medicines had improved after speaking with the pharmacist
- 100% of patients rated their appointment as good or excellent.
"Having strong and effective communication from the team is refreshing to witness and the team demonstrates this in droves. It was particularly refreshing to be able to outline the requirement and for Arden & GEM leaders to listen, digest and think innovatively about a responsive and fit for purpose proposal to meet service needs.
The quality and optimisation aspects of the service have been outstanding, interdictions have occurred that protected patients from potential harm, providing assurance that quality and patient outcomes remain at the forefront of the minds in the team involved. Clear and concise communication with stakeholders and good reporting meant both clinical and business requirements were always met.
Subject matter experts in their own right, clinical pharmacy teams are quickly becoming, what should only be considered as, mandatory quality safeguards."
Danny Smart, Chief Executive Officer at Henmore Health Primary Care