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Medicines Management Rhian Newton Lynwen Jones Definition of MM ‘encompasses the entire way in which medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care’ Cost of Prescribing in Swansea • April 07 – March 08 - £36.8m • All medicines (tablets, liquids, dressings, appliances) • Approx. £150/head of population • Estimate £3m wasted – over ordering, over prescribing, side effects, compliance • Everyone’s money Who Manages this Money? • 35 GP practices • Each has a GP prescribing lead • LHB Medicines Management Team (MMT) – 8 pharmacists (full, part-time, sessional) 6 technicians (full and part time) 1 admin support How is the money managed? • Role of MMT - ‘ensure safe, cost effective, evidence based prescribing in line with NICE guidance and NSF’s, whilst minimising waste and without detriment to patient care. • GP leads – ensure that prescribing messages are implemented in practice. NSF for Older People • Use of medicines is fundamental in many of the standards. • 4 in 5 people >75yrs take at least 1 prescribed medicine, 36% take 4+ • ADRs implicated in 5-17% hospital admissions, and whilst in hospital 6-17% older people experience an ADR • 50% don’t take medicines as intended Medication Review – What is it? Structured, critical examination of patients medication (prescribed and purchased) – • Reach an agreement with patient about treatment • Optimise impact of medicines • Minimise medication related problems • Reduce waste - why is it important in Older People? • Identifies polypharmacy, ADR’s, side effects, interactions • Identifies those at risk of falls • Confirms treatments are still needed • Ensures dosage instructions are listed • Identifies items not being taken • Ensures appropriate monitoring is carried out • Offers patients the opportunity to be involved in their care • Aids concordance - who should be targeted? • Taking 4+ medicines • Patients with recent changes to medication • Patients taking specific drugs e.g. warfarin,NSAIDs, anti-diabetics,diuretics, steroids,psych. • Recent discharge from hospital • Unsupervised OTCs • Patients with mental illness • Patients in care homes Risk of Falls • ↑ age, illness = ↑ risk • 4+ meds = ↑ risk • Type of meds = ↑ risk e.g. hypnotics, antipsyh, diuretics, Consequence – loss of confidence, anxiety, depression, ↓ mobility, #, pain long term Care Home, death Levels in medication review Level 3 Clinical medication Technical Level 2 review of review patients meds Treatment Unstructured review , opportunistic Level 1 Face to face Prescription review of meds + conditions review Review of meds Level 0 with patients full notes Ad Hoc Level 0: Ad Hoc Review • What: takes place without access to the patient's clinical notes and does not have to include a review of the full repeat prescription. • Who: Care Managers, Community pharmacists, member of practice staff, practice support pharmacist or technician, audit assistant, GP. • Examples of interventions: supply problems, drug presentation issues, compliance, over stocks. • Issues: Reviews can be helpful in identifying anomalies and highlighting patients who may need further medication review. Concordance • What medicines are you taking? • Why are you taking these medicines and what are the consequences of not taking? • How long have you been taking them? • How do you take these medicines? • Do you buy any medicines? • Do you have any concerns about your medicines • Do you think you need support with your medicines? Practical Aspects • Do you have any problems ordering/receiving medication? • Do you have any problems removing medicines from their containers? • Do you have any problems swallowing your tablets? • Do you have any difficulty reading the labels? • Do you have any problems remembering to take your tablets? Sign-posting • Community Pharmacist – assessment under DDA, ?MUR • LHB team: Technician - review meds in patients home Pharmacist – clinical review • GP Swansea Unified Assessment and SSIA Project 3.4 - ‘Do you take any medication at the moment? If so, what is it and how do you manage it?’ What problems, if any, are encountered with this question and how can we work together to help overcome them?
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