Dudley CCG plans for population health and managing polypharmacy and de-prescribing

1. Dudley CCG plans for population health and managing polypharmacy and de-prescribing Clair Huckerby Consultant Pharmacist Primary Care and Medicines Optimisation

5. Managing Polypharmacy and de-prescribing De-prescribing – the cure for the disease of polypharmacy De-prescribing – the process of tapering, stopping or withdrawing unnecessary and inappropriate medicines Dilemma- which medicines do you discontinue?

6. Is it worth it? • Meds rec (Karnon et al) evaluated that ROI was £13.64 per patient for meds rec by a pharmacist • variation according to skill set • meds rec is everyone's business • If one drug with an average unit cost of £9.87 (and an average 6 repeats) is stopped for one year – this would reduce prescribing costs by ~£72,000 per 100,000 population • It is estimated that the cost of hospitalisation due to avoidable ADRs is between £58,500 and £407,000 per 100,000 population

7. Systematic, population-based and data-driven

9. Next Steps of HARMs project is to focus on GI bleeds

10. Bowtie method

11. Practice Based Pharmacists Outcomes 2016/17 • 58,294 patients reviewed • 45,713 interventions documented • 4,310 dose optimisations • planned changes (5,824 generic and 3,621 branded) • 4,447 drug discontinuations • 4,424 preventative medicines initiated • 1,543 concordance and compliance issues resolved • 1,136 safety issues addressed • 2,152 formulary issues resolved • 16,473 medicines reconciliation completed • 16,556 changes to medicines actioned • Medications reviews completed in 5,050 patients with LTC’s and 1147 patients newly discharged from hospital, 105 housebound patients, 375 patients in Care Homes, 3,364 patients on 5 or more medicines with 2 or more LTCs, 5,578 reauthorisations. Saving at least £174K on these medication review related interventions • 369 HARMS related interventions accepted • 170 patients newly diagnosed with hypertension

12. Dudley POD-Initial activity and interventions/ impact £76.5K of GP time saved between October and July- over 3 practices This is approx. £38K per year per practice of GP time potentially saved (£1.7m for whole CCG) on top of the items reduction associated savings “for every £1 invested in PBP provision, savings of £4.73 may be realised “

14. Recommendations in order to get population focus • Strong clinical leadership- overarching and peer review • Pharmacists focussing on their area of expertise- working as part of an MDT • Applying national and local strategy and operationalising it • Providing Systems Leadership • Understand population needs • Prioritise those needs • Numbers • Impact • Ability to modify risk • Design interventions and using innovation • Implement- new service models e.g. POD • Review and measure