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NHS tackles care home over-medication

Integrated care systems lead change

nhs

The NHS in England is stepping up its efforts to rationalise medication for care home residents and cut back on unnecessary and potentially harmful overuse of medicines.

The new nationwide initiative builds on successful regional pilots pioneered by the new regional integrated care systems (ICSs) which have seen positive results for patients, slashing the numbers of emergency visits to hospital, and resulting in major cost savings.

For the pharma industry, the pilot is a good demonstration of how the health service is getting smarter about using its resources and also focusing on patient needs. The industry will of course lose out from fewer prescriptions written, but will endorse more appropriate prescribing – and hope that money saved will free up funds for new medicines targeted at the right patients.

Around 400,000 people live in England’s 17,000 nursing and residential care homes with one in seven residents aged 85 or over, and often have one or more long-term health conditions – such as dementia, high blood pressure, diabetes and heart disease.

On average, care home residents are prescribed seven medicines a day, with many taking 10 or more. This costs the NHS an estimated £250m each year, and NHS England has repeated fears from charities that these vulnerable older people are being subjected to a ‘chemical cosh’.

The new £20m plan will see 200 new clinical pharmacists and pharmacy technicians being employed to support care home residents, improve quality of life, cut hospital stays and reduce over-medication.

Care home residents spend around 2m days in hospital each year and account for about 250,000 emergency hospital admissions.

Around 35%-40% of these admissions are thought to be avoidable, including efforts to tackle overmedication.

The expanded initiative is part of a strategy to improve older people’s health and care – and cut costs – which is included in the NHS Long Term Plan, which was launched in January this year.

The programme reflects NHS England’s overarching strategy of integrating services around the patient, while improving outcomes and aiming to cut costs at the same time. Despite being given an extra £20bn in funding last year, experts warn the NHS is still struggling to meet demand on its budget, with waiting times for A&E and cancer treatment steadily lengthening.

The scheme has already proven itself a success in 14 areas in England, giving ‘wrap around care’ for care home residents, including improved GP support, more visits from specialists like dieticians and clinical pharmacists.
Studies suggest one in 10 older people’s admissions to hospital is linked to their medicine intake, with the majority of these thought to be avoidable with better care and support.

England’s chief pharmaceutical officer Keith Ridge said: “Rather than assuming there’s a pill for every ill, increasing the availability of specialist health advice in care homes will mean residents get more personalised treatment, reduced chances of being admitted to hospital and people will have a better quality of life, for longer.”
He added: “Failing to understand properly residents’ care needs can mean health problems get missed, which among older people risks frailty and falls, leading to long-term problems and lengthy hospital stays.

Results from pilots have been impressive. When introduced in Nottingham, the approach led to 44% fewer ambulance call outs, 48% fewer ambulances visits to the emergency department, 29% fewer A&E emergency attendances, 11% fewer emergency admissions and 28% fewer overall admissions.

Meanwhile medicines wastage was cut by 54% leading to a saving of £120,000.

Article by
Andrew McConaghie

10th May 2019

From: Healthcare

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