MEDICINES and Older People

Hira Singh

Prescribing Adviser

(Middlesbrough PCT and Redcar & Cleveland PCT Medicines Management

Team)

March 2008

Who are we?

What are Medicines Management Services?

£50m spent on drugs in primary care across £50m spent on drugs in primary care across South Tees.South Tees.

NSF for Older People (March 2001)

Medicines SupplementAIMS

To ensure that older people:To ensure that older people:

• gain maximum benefit from their medicines to maintain and increase their quality and duration of life.

• Do not suffer unnecessarily from illness caused by excessive, inappropriate or inadequate consumption of medicines.

• Are not denied access to medicines that would benefit them

Some Statistics…..

COMPLIANCECOMPLIANCE OR CONCORDANCECONCORDANCE

• As many as 50% of older people may not be taking medicines as intended– Why might this be?– (communication between primary & secondary care)

• Older people and their carers need to be more involved in decisions about their treatment.

• Older people and their carers need more information about the risks and benefits of their treatment.

PRIMARY / SECONDARY PRIMARY / SECONDARY INTERFACE ISSUESINTERFACE ISSUES

• Poor two-way communication between hospitals and primary care

• Changes in medication after discharge from hospital (unintentional changes are too frequent)

ACCESS TO INFORMATION AND ACCESS TO INFORMATION AND SUPPORTSUPPORT

• Access to pharmacy or surgery may be difficult, reducing contact with a range of health professionals.

• Carer’s potential contribution and needs are often not addressed (Informal and formal carers)

• Advice on practical aspects of medicine taking may be lacking.

Prescribing medicines is the most Prescribing medicines is the most frequent NHS healthcare interventionfrequent NHS healthcare intervention

Medicines Management team have been involved with:

FallsFalls Mental Health

Continence Stroke Intermediate Care

Review of repeat prescribing systems

Care Homes

Medication review Education / Training

Training included awareness sessions on medicines for hospital social workers, carers etc

SettingsSettings

Home (independent) Sheltered

housing

Home –with domiciliary care

Respite careIntermediate care

Long term residential care

Acute hospital care

Home with informal carer support

Who may be involvedWho may be involvedWith prescribing & managing medicines?

Informal carers

Domiciliary Care providers

District Nurses

GP

Consultant

Pharmacist –community, primary or secondary care

Care Home staff (nursing or non-nursing)

Social Care

Intermediate Care staff

What have we done so far?What have we done so far?

• In Care Home

• clinical medication review for residents

• medicines policies and procedures (in home care setting)

• training for staffo Worked to improve good quality training for carers in medicines

o South of Tees Group / Regionally

• Care Home Advisory Pharmacist

NB ‘Handled with Care’ report CSCI

• Practice Pharmacist in every GP Surgery

Domiciliary CareDomiciliary Care

Part of a Multi-agency working group

Its Aims: - To promote independence and safe, effective

use of medicines

• Standardise policies across South Tees

• Reduce reliance on MDS as the only means of support

• Consider health /social care boundary issues

• Decrease admissions to long term care by improving safe & effective use of medicines

Intermediate CareIntermediate Care

• Pharmaceutical Care Award for pharmacy technician project

• Cross-boundary working (strategic group)

• Accessible to social care teams

• Links with clinical medication review in practices

Medicines Awareness SessionsMedicines Awareness Sessions

• Local Authority employed carers

• Social Workers

• Discharge liaison teams

• District Nurses

• Occupational therapists

• Intermediate Care teams

....and patients and carers?and patients and carers?

Information leaflets (Medicines and Falls)

‘Sloppy Slipper’ events

Talks to older peoples groups / carers groups

Ask About Medicines Week – in older peoples clubs/nursing homes, council day centres & friendship groups.

PCT Life Store

Medication Review

How do we make more How do we make more progress?progress?

• Joint working

• collect good information about why things go wrong – share it, and learn from it!

• discharge planning and process

• more access to pharmacist help in social care settings

• ensure access to good quality training /education about medicines for all staff handling medicines.