Working much more collaboratively, with a full range of partners, could improve the use of medicines in the NHS – so saving money and improving care, says Jyotika Singh, principal consultant, Wilmington Healthcare
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There is an irony within the term “medicines optimisation” because the work it describes is, in many ways, not currently optimised.
The process itself is a valuable one. Ensuring the right patient gets the right medicine, at the right dose and time for the right indication, is good value and is important for the patient and the system. Medicines optimisation offers opportunities to improve patient care, addressing complex issues such as non-compliance with medicines, and avoidable polypharmacy. In doing so, it can drive much-needed savings across the system.
At present, however, the process is often being hindered by a lack of shared understanding of each individual patient. It is not always easy for medicines optimisation or management teams to work collaboratively with the rest of the system, with members sometimes unable to get a sense of what is happening on the ground.
Where patients do have regular medication reviews, the outcomes may not be easily shareable with all the other healthcare professionals they may encounter across the system. This can lead to inefficient use of medicines – for instance a prescription from secondary care could be similar to or duplicate a medicine already trialed in primary care. Playing into this are systemic and cultural factors that may lead a clinician to prefer prescribing medication rather than potentially being perceived as doing nothing.
In addition, the people who provide medicines to patients are not always involved in conversations about what works best for that patient. Yet community pharmacy is a potential source of real knowledge – not least knowledge of which individuals may be experiencing difficulties with their medicines, or of which are taking multiple drugs unnecessarily.
If medicines optimisation is to work as effectively as it could and should, such issues need to be addressed and medicines optimisation needs to be “patient centric”. To consider how, Wilmington Healthcare recently ran two roundtable discussions. The events were supported by Aspire Pharma and brought together individuals from across the service. Together they considered how the current approach to medicines optimisation might be refined with a patient-centric approach to medicines optimisation centricity.
The need to work more collaboratively emerged as a strong theme during both events. This need is not merely confined to different parts of health and social care services. It also involves more collaborative work between such services and patients themselves, supporting individuals to be at the centre of decisions about their medications.
Finally, it is likely there is a part for industry to play. Pharmaceutical companies have the benefit of working with NHS leaders across the country. This makes industry an excellent source of intelligence, information, and best practice case studies demonstrating the value on the use of the correct medicines.
Local and national data insights might be another area in which the pharmaceutical industry could lend support. Knowing which medicines are right for which cohorts of patients, and evaluating the quality of the outcome once a medicine is required, are both crucial to effective optimisation. Data tells this story and is something with which industry is well equipped to help.
Videos based on interviews with some of the roundtable participants, and a white paper which summarises the discussion, are available here. Clicking on this link will take you to an external website hosted by Aspire Pharma.
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