“Show me your meds please?”
A new model of care asking a simple screening question, during routine home visits by community staff, provides potential for massive reduction in medicines waste with subsequent environmental and NHS savings, along with improved person centred care.
Encourages professional curiosity. Holistic care, shared decision making. Prescribing for the person with the illness, not just the illness.
Appropriate prescribing. Medicines waste, financial and environmental. The biggest waste of medication is those prescribed which are never used. Reduced carbon emissions, reduced admissions.
Details
A new model of care asking a simple screening question, during routine home visits by community staff, provides the potential for massive reduction in medicines waste with subsequent environmental and cost saving benefits, along with improved individualised patient care.
The problem
The role of the Complex Care GP in South Somerset is to perform holistic assessments of patients’ needs within their homes.
These patients include people who have recently been discharged from hospital, had frequent admissions to hospital and/or are involved with multiple services.
During our assessments, we identified a large number of patients not adhering to their medication as prescribed and subsequent wastage of large amounts of medication. This was only apparent from asking to see their medication, and would not have been identified otherwise. All but one of the people had had a medication review in the proceeding year which had not identified poor adherence to medication as prescribed.
In our first pilot we identified 40 patients not adhering to their prescribed medication regime, this accounted for 1 in 4 of people assessed.
Viewing medication is not part of the normal medication review, however, if we perform this simple task we identify a cohort of the population that are at increased risk from adverse events from erratically taking medication, poor optimisation of long term conditions, and missed diagnosis (e.g. dementia). This will also reduce medicines waste and save resources for the NHS. Currently medicines account for 25% of CO2 emissions within the NHS in England each year, and £300 million pounds is wasted on medicines that are thrown away or stockpiled.
Evidence
The solution was a simple screening question asked on routine visits by community staff: “Show me your meds, please?”
The staff reported after simply viewing patient’s medications, if they had any concerns that the medications were not being taken properly. This included the complex care team, health coaches, district nurses, community physios, adult social care etc.
This information was then fed back to primary care and the patients were discussed in huddles (Multidisciplinary meetings) to decide which staff member was most appropriate to follow up the patient. Follow up could range from a phone call to a comprehensive assessment aligned to patient goals. The Primary Care Network (PCN) pharmacist, pharmacy technician, complex care team (which includes GP, nurse and support worker) and primary care team have all had a role.
The first pilot over a 3-month period identified 40 patients not adhering to their medication as prescribed.
1049 individual months of unused prescription items were identified.
Wasted medication was valued at £10866
It is estimated that every pound spent on pharmaceuticals generates greenhouse gas emissions of 0.1558kg CO2 per pound (£), representing avoidable CO2 emissions of 1693 Kg.
39 medications were stopped providing predicted cost saving over the next 12 months of £3529 and 549 Kg CO2 emissions prevented.
Medication regimes were simplified in more than 50% of cases.
Social prescribing was initiated in 30% of cases.
New cognitive impairment was identified in 35% of cases.
