MEDICINES OPTIMISATION
mike flock, Professor mike Scott, cathy harrison and john Stanley
ImPact Of POOR mEdIcINES OPtImISatIONS NEEdS REcOgNISEd
a major conference which has taken place in Belfast, Northern Ireland, has heard how more action is required to tackle a widening gap in the physical health of patients with mental health problems.
the conference, which was organised by the Northern Ireland based medicines Optimisation Innovation centre (mOIc), the Pharmacy management organisation (
www.pharman.co.uk) and sponsored by Sunovion Pharmaceuticals Europe ltd, heard that greater effort needs to be made to recognise the impact of poor medicines optimisation in patients with mental health issues.
five patients had 3674 drugs individually assessed for medication appropriateness. Both individual and total drug maI scores on admission to, and discharge from Ic reduced by a statistically significant figure.
during the same time period, the Northern health and Social care trust (NhSct) introduced trust outreach medicines optimisation clinics for care home patients. again, this initiative yielded significant drug cost savings and resulted in a fourteen per cent reduction in a&E admissions to antrim area hospital.
the objectives of this project were to demonstrate the benefit of holding outreach clinics in nursing homes with a consultant pharmacist, to rationalise the use of medicines, and to assess if there was an impact on the number of hospital admissions and emergency department attendances by nursing home patients.
Over the two-year project, a total of 727 patients were reviewed in 16 nursing homes. data on patient age, number and types of drugs taken, and types of interventions was collected for all patients reviewed. this data was presented to the home at the end of the series of clinics, and education sessions for nursing staff offered where necessary.
In addition, monthly admissions and emergency department attendances for all the nursing homes visited were monitored. more detailed data was collected for 100 patients on the type of intervention, Eadon grading of interventions, medication appropriateness using the medication appropriateness Index (maI), and drug costs (kardex calculations using dm & d prices).
In the 727 patients reviewed there were an average of 2.7 interventions per patient. for all clinics, individual and total maI scores decreased significantly after clinic review.
Since april 2015, the project has focused on refining these two models and replicating them in each of the two trusts. Interim results have demonstrated that both of these consultant pharmacist-led medicines optimisation models of care are robust and reproducible, with similar positive patient and economic outcomes being again demonstrated. full results will be available in 2017.
this work on the development, refinement and evaluation of medicines optimisation models of care in older people has resulted in an evidence base supporting the rollout of these innovative new pharmacy services throughout Northern Ireland. •
Speaking at the conference, mOIc director Professor mike Scott, said that the current situation where patients with mental health issues have a shorter average life expectancy of up to 20 years is unacceptable.
'we’ve been hearing for some time now that more needs to be done to tackle the issue of shortened life expectancy as a result of mental illness,' Professor Scott told delegates.
'Oxford University outlined in 2014 how mental health problems can have a greater impact on life expectancy than heavy smoking and this conference aimed to look at how better medicines optimisation can tackle this serious problem. what we heard was encouraging as the issue is clearly on the radar of the department but we would like to see this become a priority going forward.'
'for this equality of priority to be achieved,' added consultant psychiatrist and conference chairman, gerry lynch, 'we need to see equal access to the most effective and safest care and treatment, equal efforts to improve the quality of care, the allocation of
time, effort and resources on a basis commensurate with need, equal status within healthcare education and practice, equally high aspirations for service users/carers – and equal status in the measurement of health.'
the conference looked at issues such as the role which pharmacists can play in delivering better medicines optimisation for mental health patients, through an integrated approach, as well as a range of measures aimed at ensuring better concentration on the physical health of these patients.
Speaking as the conference closed, the Pharmacy management chief Executive Officer, john Stanley, said he was delighted to have played a positive role in taking forward discussion of the need for better medicines optimisation in mental health and looked forward to hearing more from the department regarding their proposals going forward.
'It’s often remarked that the discussion of issues around mental health has moved forward significantly in recent years. this is good to see but given some of the statistics and the human impact of poor medicines optimisation in this area, there is clearly much work to be done. we look forward to hearing more from the department of health in Northern Ireland and across the Uk, as to how this issue will develop in the near future.'
thE cURRENt SItUatION whERE PatIENtS wIth mENtal hEalth ISSUES haVE a ShORtER aVERagE lIfE ExPEctaNcy Of UP tO 20 yEaRS IS UNaccEPtaBlE
PhaRmacy IN fOcUS - 25
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