Medicines education for patients and Patient Led Clinical Medicines

Reviews TM

The Communities Fund Bid Presentation to NHS Kernow

5th January 2017 Steve Turner

www.carerightnow.co.uk steve@carerightnow.co.uk

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Medicines education for patients & Patient Led Clinical Medicines Reviews

TM

1. What is this?

2. How does it work?

3. Patient stories

4. Evidence to date

5. The proposal

6. Future challenges

7. Questions Care Right Now CIC ©

Click on the title for more on line information

What is a Patient Led clinical Education?

Following a group session on medicines. Citizens- patients have the option of reviewing their medicines in a 3/4 hour session with two health professionals (a prescriber and a pharmacist).

• A guided conversation

• Chance to discuss options in more detail

• Safe and supportive environment

AIM

To allow people the option to lead on their own care

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The Groups session aims:

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Example group session materials

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How do the individual sessions work??

Suitable for all.

Focused on those with most need.

Optional and confidential.

Not specific to any condition, illness or patient group.

We provide people citizens / patients with an action plan.

This approach educates and empowers the individual to take back responsibility and control for their health and wellbeing.

We don’t take a position on any approach if it’s safe and it works.

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What is the bid asking for? • Clear criteria – ways to reduce the burden on

acute health care .. deliver more effective adult social care…mental health support

• Clear Plan – ..how many people it will impact on…how the model will create wider change

• Resources - committed to the project

• Strong partnerships – endorsed by at least one statutory provider and local authority

• Learning commitment – share the project widely and take part in evaluation…peer groups, learning resources networking

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What we can provide? • Clear criteria – group education and targeted focus on

engaging ‘high cost’ individuals

• Clear Plan – groups of 15 followed by optional individual sessions, plus tailored resources & involvement of patient groups and the local community

• Resources - links with existing initiatives and makes best use of skills

• Strong partnerships – links to NICE Meds & Prescribing Programme, CTI and #WHIS

• Learning commitment – clear evaluation criteria which have been piloted, commitment to education and learning

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Patient stories

Martin

‘In the support session you listened to me, and helped me work out what I needed to say. I gave the notes to my G.P. who changed my medicines and made the referrals you suggested. I now no longer walk with a stick, and feel a lot better. I thoroughly recommend these sessions’ Martin, Shepton Mallet, May 2016

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Patient stories

Ian (not real name)

I've tried everything, my GP is different every time I visit & doesn’t listen.

I’m in constant pain. I drink 8 cans of Stella a night to get to sleep.

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Patient stories

Julie (not real name)

Every time I try and go on a holiday to my daughter and grandchildren I end up in hospital. I don’t feel in control.

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More patient stories • ‘I’ve made a plan for the pain with my Dr, using the info and help given…’ Attendee Nov

2015.

• ‘The course helped me solve a (health) problem I’ve had for ages. Its’ gone now!’ Attendee March 2015.

• “My counsellor says my anxiety and depression have improved. My confidence levels have gone up a lot. I’m better at talking on the phone, more assertive. I’m more proactive, for example, I dealt with my referral to the pain clinic straight away rather than leave it. I’ve made a plan for the pain with my doctor, using the information and help given by Care Right Now. I was able to be more assertive when booking my appointments and it got the results; I was put on medication for my pain and referred to the pain clinic. Other people have noticed the positive difference in me”. Attendee. March 2016

• ‘The great thing about the course is that it’s not mandatory and it’s not just given by a couple of people. The trainers were genuine people who listened and who we can trust. You didn’t have a list of things to get through with us you concentrated on what we asked and listened. Once the word gets around everyone will want this.’ Attendee April 2015.

• ‘You should listen to those guys. You will learn something’ April Attendee 2015.

• ‘Gives you the courage to question’ May Attendee 2015.

• ‘We all have different illnesses but we experience the same things and need to talk about it’ May Attendee 2015.

• ‘…really helpful…you need to think about what you’re going to say to the GP before you get there and make the time count…so I can get my point across’ May Attendee 2015.

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Evidence to date

1. WEMWBS

2. Patient stories and testimonials ( examples shown)

3. Thematic analysis discussion points & presenting issues

Not known (effect on):

• Cost of medicines and treatments

• GP time

• Referrals Care Right Now CIC ©

Warwick Edinburgh Mental Wellbeing Scale

• Warwick Edinburgh Mental Wellbeing [WEMWBS] Scale scores shows mental wellbeing improved over the course of the project

• Our study showed an average increase of 6.3 points. N= 30. Time period covered Jan to March 2016.

• A difference of 3 to 8 points is considered meaningful, demonstrating that ‘mental wellbeing improved over the course of the project’.

Reference: Using WEMWBS to measure the impact of your work on mental wellbeing: A practice-based user guide (2015) NHS Scotland. WWW: http://www.healthscotland.com/documents/6074.aspx (accessed 3/4/2016)

Thematic analysis of discussion points

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Thematic analysis of presenting issues

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13

9

7

5

3

3

3

2

2

2

2

1

1

0 2 4 6 8 10 12 14

MENTAL HEALTH ISSUES

BRIEF FOLLOW UP GIVEN

ENCOURAGED TO ENGAGE

ANGER ISSUES

USE OF ILLICIT DRUGS

SUICIDAL IDEATION

RISK / SAFEGUARDING ISSUE

NOT TAKING AS PRESCRIBED

SUICIDAL IDEATION WITH METHOD

BENEFITS ADVICE NEEDED

HOUSING ISSUE

GUIDELINE MISSED

BORROWED MEDICINES

Issues brought up by patients. As noted in reflective log (individual sessions). n= 27/35

Cost savings? Our pilot work was part of a Condition Management programme commissioned by the Department of Work and Pensions.

This was measured by progress back to employment, where it was successful in its aims.

We asked people who had a medicines review to feed back on progress. In one cohort (of 15 people) two patients indicated that they no longer see the G.P. weekly as their condition is more stable. A reduction from weekly to monthly visits to the G.P. saves £2,895 per year.

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Proposal for measuring outcomes

Outcomes to be measured are:

1. Improving quality of life

2. Reduce costs of care and support services

1. Improved wellbeing as indicated by Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS] scores already achieved see slide 10

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Measuring Improved quality of life • Reduction in inappropriate referrals to other services

(including 'bouncing' referrals)

• Improved adherence to medicines - e.g. stopping inappropriate or ineffective medicines

• Improved Patient Participation Group involvement

• Evidence of more appropriate visits and contacts

• Personal action plans and course feedback

• Improved mood (PHQ9)

• Return to employment or meaningful occupation

• Identification and management of previously unmet needs

• Greater uptake of lifestyle change measures and alternatives to medicines Improved mobility

• Reduced need for support from carers (paid or unpaid)

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Reducing cost of care and support services

• One prescription from a GP costs (on average) £41.35.

• A GP visits costs £45 each for a 11.7 minute consultation.

• A telephone consultation with a G.P. costs £27 for a 7.1 minutes.

• A home visit from a G.P. lasting 23.4 minutes costs £114.

• A 15 minute appointment with a nurse in a GP practice costs £13.

Reference: G.P. visit costs - Personal Social Services Research Unit [PSSRU] 2013 'Unit Costs of Health and Social Care 2013'

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The proposal

1. Carry out project in 3 cohorts, 2 G.P. practices and one by open invitation (not linked to a G.P. practice).

2. Offer reach of the 3 cohorts 5 group sessions for max 15 people followed by a day set aside for optional individual reviews.

3. Link the cohorts to tailored on-line resources and signposting.

4. Evaluate the project, produce present and document findings and disseminate this.

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Challenges

1. Engaging G.P.s and recruiting people to attend the courses

2. Formal evaluation and benefits realisation exercise

3. Governance of the model and development

4. Spread and sustainability

Click here for the Detail Aid

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