In September 2015, the medicines optimisation service (MOS) was set up within Weymouth and Portland, Dorset. The MOS pharmacist conducts in-depth domiciliary consultations with patients to improve adherence and prevent harm from inappropriate medicines administration or prescribing. The service targets patients aged over 75 years with polypharmacy, on admissions avoidance care plans or living in care homes.
Service design and provision involves collaboration across primary and secondary care. The MOS pharmacist spends 70% of the time working in primary care alongside GPs, community pharmacists and the multi-disciplinary team, and 30% of the time working in hospital, attending consultant-led ward rounds. Joint working with Dorset Clinical Commissioning Group (CCG) pharmacists and the Weymouth and Portland GP prescribing lead has ensured service design meets locality needs. Collaboration with Southampton-based IT consultancy Purple Computing enabled development of a bespoke database, ClinicalCapture, which creates the platform for accurate recording of interventions and associated cost savings.
A service evaluation was undertaken in July 2016 to evaluate the impact of the MOS on medicines adherence, medicines-related problems, cost effectiveness, patient satisfaction and prescriber perspectives. Over 8.5 months, 389 patients were seen by the service and 1,380 clinical interventions were made to stop or prevent medicines-related problems. The most common clinical intervention was to stop a medicine and the most common reasons for intervening were because there was no clear indication or to stop or prevent adverse effects. Around 58% patients had experienced an adverse drug reaction, which could have resulted in actual harm. If not addressed by the MOS, a proportion of these may have resulted in hospital admissions.
In the 389 patients reviewed, 370 interventions were implemented to help patients more safely manage their medicines at home and improve adherence, such as issuing compliance aids, advising on dose timings and intervening to reduce pill burden, where patients were struggling to cope. A total of 611 educational interventions were made to improve medicines adherence, most commonly educating on the indications and possible adverse effects of medicines.
The MOS was proven to be cost effective, although associated with cost pressures of £59,463 (band 8a pharmacist, administrative support, IT and travel costs). However, cost savings of £114,048 per year (cost of medicine stopped assuming dispensed every month for a year) were made, thus it contributed towards NHS efficiency savings.
A retrospective postal questionnaire indicated that patients value the MOS. Patients thought that interventions have empowered them to be knowledgeable and adherent with their medicines and enable them to better manage their health at home. The high response rate (64%) in this predominantly housebound population indicates patients are well engaged with the service and thought it is beneficial for provision within their subset of the local population. Around 96% of patients were satisfied with the service and would recommend it to others.
An online survey indicated that most GPs (96%) were satisfied with the service and most (>90%) found every aspect of the MOS useful; particularly making recommendations for optimising and rationalising treatment. All GPs thought the MOS contributes towards safer patient care via increased medication knowledge and reduced harm from inappropriate polypharmacy. GPs are well engaged with the service (97% response rate to recommendations) and see the pharmacist’s recommendations as valid and reputable (82% recommendations were actioned; only 3% not actioned owing to GP disagreement).
It has been concluded that the MOS provides a valuable service for patients and is embedded within the primary care services already provided by the NHS in Weymouth and Portland. We now aim to secure funding for continuation of the service beyond the two-year pilot.
Locality GP clinical pharmacist
Dorset County Hospital NHS Foundation Trust
Declaration of interest: Mrs Hart’s husband is the managing director of Purple Computing Limited.