UPDATE MEDICINES MANAGEMENT
the best possible use of their medicines through shared decision-making and better patient education. Programme consultant in medicines management
at NHS West Midlands, Richard Seal, believes it is this active support for patients that will really make the difference. He highlights the importance of speaking to patients about the medications they take and ensuring it’s not just a last minute add-on to end a consultation. Up to 50% of prescription medicines are not taken as directed and around 20% are thought to be never taken at all. In his experience, the more patients understand how a medication will benefit them, the more likely they are to take that medication in the long-term.
“Medicines management has become really a population-based bean-counting exercise, though that wasn’t its intent; whereas optimising medicines is more about the individual and the outcome”
Of course, these are just estimated percentages, as it is often difficult to track the true numbers. Why this happens often comes down to two factors: intentional and unintentional non-compliance. Reasons for not wanting to take medications can be attributed to anything from cultural preference to hearsay or taking the wrong advice. Meanwhile, unintentional non-compliance can derive from forgetting to take it to side effects standing in the way. Both types of non-compliance can be somewhat rectified through better communication and information at the point of consultation, but wider education at a locality level can only be of further benefit.
MANAGEMENT V. OPTIMISATION In our conversation, Seal introduced me to the phrase “medicines optimisation”. The slight change in wording belies the significant change in culture that he believes needs to occur throughout the health professions as we move into the commissioning landscape. Rather than thinking reactively about the management of medications, commissioners should be thinking proactively about optimising their use to improve patient outcomes as well as reduce spend on conditions in the long-term. Using the right medications in the right way could hold the answer to many of our financial woes. “In philosophy, the shift is to making it more outcomes driven
and patient-centred,” Rao explains of the difference. “Medicines management has become really a population-based bean-counting exercise, though that wasn’t its intent, whereas optimising medicines is more about the individual and the outcome.” ‘Optimisation’, he believes, gives commissioners more freedom to find the right solutions for different patients and take a more bespoke approach to their care.
PARTNERSHIP WORKING It is important that CCGs take as much support as they can when managing medicines. Pharmacists, for example, play an important role with medicines reconciliation – where they check and amend errors in the clinician’s prescription – and act as an important safety net in the prescribing process. By working closer with pharmacists, hospitals, patients and even pharmaceutical companies where appropriate, GPs and commissioners will come that much closer to optimising the medicines. Raymond Lee, chairman of Central Lancashire’s
Local Pharmaceutical Committee, says it makes sense to include community pharmacy at the earliest opportunity when considering care pathways. “There are nationally commissioned services such as the New Medicine Service (NMS) and Medicine Use Reviews (MURs),” he explains. “By joining these services to the care pathways, it reinforces the messages of taking medication appropriately and helps to promote healthy lifestyle interventions such as smoking cessation, alcohol awareness and weight management.” Putting clinicians in the driving seat looks to prove favourable for medicines management. It is now up to the CCGs to take the opportunity, see the medicines budget as the investment it should be and ensure patients have the right tools to treat their conditions responsibility and sustainably. “In order to achieve the level of cost savings that CCGs need to deliver, a whole systems approach is required,” concludes Lee. “Adopting previous QIPP savings will simply not be enough. Having an integrated care pathway approach whereby all clinicians have input and are able to work together, particularly at the interface between services is where the real savings can be realised. Clinicians need to have the moral courage that services may be better served by utilising the skills of others rather than trying to protect existing services and income streams.” Commissioners, medicines management is in your hands. Use it wisely.
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