MEDICINE MANAGEMENT
ally more expensive; however, prescribing complex regimes that dementia patients won’t stick to does not make sense either. Isn’t it preferable to invest up-front to save the cost, both human and fi nancial, of hospitalisation or emergency care further down the line?
Technology talks Consistency counts
With the health service now focusing more on outcomes rather than output, every investment in health must generate a measurable return. The move towards the digitisation of patient records and e- prescribing shows the NHS is embracing technology in the drive to be leaner, and managing medication for dementia suffer- ers is no different.
As in-home care for dementia sufferers be- comes preferable to residential homes, the role of carers and nurses in administering and policing medication regimes must be fulfi lled in an alternative, more cost effec- tive way. This is where technologies de- signed specifi cally to aid adherence come into play.
Monitored dosage systems such as Bio- dose incorporate visual reminders and safeguards to support patients and carers as they manage and administer medica- tion. Pre-measured, colour-coded and even microchipped medication management systems have been found to be effective in reducing the risk and cost of non-adher- ence, and Biodose trials indicate an 80% increase in adherence in care homes and domiciliary care.
That said, secondary care has been slow to adopt technologies like these, despite the untapped opportunity to get a solid return on the NHS’ £8bn-plus drug bill. The suc- cess of MDS in care homes and in-home care has set a precedent for similar savings as part of hospitals’ and GPs surgeries’ dis- charge procedures.
Pharmacists fund 100% of the cost of mon- itored dosage systems in care homes and domiciliary care, in return for an increase in revenue. While this is not a viable model
Dementia sufferers can be easily confused and often rely on the shape and colour of the tablet or packaging to identify which medicines to take. It’s estimated that con- fusion over packaging and labelling in- structions causes a third of all medication errors.4
Currently, pharmacy contractors
are incentivised to source the cheapest ge- neric medicine or equivalent import and a
in primary or secondary care and would incur an extra initial cost, technologies like these could pay dividends in the long term, reducing the estimated annual £300m wasted on unused medication and reduc- ing hospital readmissions.3
In short, the
benefi ts of keeping patients out of hospital far outweigh the costs.
claw-back mechanism penalises those that don’t. As a result, patients can be given different brands of medicines each time their prescription is dispensed, with dif- ferent packaging and different-shaped or -coloured tablets. This practice carries sig- nifi cant dangers to confused patients and compounds the adherence problem.
There is a dire need for commissioners to work with local prescribers and pharma- cists to ensure consistency of supply for patients with dementia – even if it means prescribing branded medicines. It is a false economy to prescribe the cheapest generic medicine if it leads to a patient with de- mentia being admitted to hospital when they aren’t able to manage their medicines.
Patient adherence is a complex issue with a range of causes and no ‘magic bullet’ to ad- dress it; above all, it requires pharmacists, prescribers and budget holders to work together. Overcoming the obstacles to ad- herence, particularly in dementia suffer- ers, should be a national priority. Helping patients and their carers manage medica- tion responsibly, whether through changes to policy, the introduction of medication management tools, or the regulation of the generics market will support the NHS’ ef- fi ciency targets and ensure a long-term em- phasis on economical and patient-centric outcomes, not just output.
References:
1. Medicines adherence. Involving patients in decisions about prescribed medicines and supporting adherence. NICE 2009 (statistics refer to medication adherence in long term conditions) 2. Report published by National End of Life Care Intelligence Network, June 2010
3.
www.medicinewaste.com 4. Design for patient safety: A guide to the graphic design of medication packaging 2nd Edition, NPSA 2007
David Pruce FOR MORE INFORMATION
Visit
www.pruceconsulting.co.uk or
www.biodose.co.uk
national health executive Jul/Aug 11 | 65
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