Consultant Pharmacist Case Management of Older People in Intermediate Care: a New Innovative Model

Abstract

Rationale, Aims and Objectives: In 2011, ‘Transforming Your Care’ outlined the remodelling of Health and Social Care in Northern Ireland (HSCNI) UK, specifically recommending better integration of hospital and community services for older people. This work aimed to evaluate consultant pharmacist case management for older patients admitted from acute to intermediate care continuing back into the community setting, given the importance of such a transition to person-centered healthcare. Method: On transfer to intermediate care, the consultant pharmacist determined the Medication Appropriateness Index (MAI) for each drug prescribed. Individualised pharmaceutical care plans were implemented with clinical interventions recorded and graded using Eadon criteria. Cost savings resulting from interventions which prevent medication errors/Adverse Drug Events (ADEs) have been estimated using the model as described by the University of Sheffield School of Health and Related Research (ScHARR); these were applied. Drugs stopped/started were costed using the NHS dictionary of medicines and devices (dm+d). Case management continued via communication with GPs and/or community pharmacists and post-discharge patient telephone calls/home visits. Results: Three hundred and fifty-five patients had 3674 drugs assessed for medication appropriateness; both individual and total drug MAI scores on admission to and discharge from intermediate care, were significantly reduced (Wilcoxon signed rank test, p<0.001, n=355). An average of 2.5 clinical interventions per patient were made, with 84% being self-graded as Eadon ≥ Grade 4 (significant interventions resulting in improved care standards). Clinical interventions yielded potential savings of £63-144k pa whilst annual drug cost savings were £68k. Conclusion: This project demonstrated consultant pharmacist case management results in both cost savings and more appropriate prescribing with safer, seamless and more person-centered care.

Post discharge medicines use review (dMUR) service for older patients: Cost-savings from community pharmacist interventions

“…This is similar to the 53% reported in Eadon's original (hospital-based) study, but lower than the 84% reported during an analysis of the effect of consultant pharmacist case management of older people in intermediate care. 15,17 This lower value is perhaps expected as, community pharmacists are unlikely to possess the resources (in terms of specialist knowledge, multidisciplinary team support, time for repeated follow-up and ability to conduct home visits) afforded to a consultant pharmacist in care of the elderly. Assigning a monetary value to these interventions appears to show a four-fold return on investment, even when using the most conservative estimate of value delivered per dMUR conducted.…”

The Development of an Enhanced Palliative Care Pharmacy Service during the Initial COVID-19 Surge

“…The model was developed in 2009 and is, therefore, likely to underestimate the current healthcare costs, and it is unclear if this model is applicable to the PEOLC population. However, its use is established within pharmacy services in Northern Ireland and was warranted in the absence of a suitable alternative, with mitigation measures employed to compensate [24][25][26]. Despite these limitations, economic analysis of the interventions demonstrates that not only does the palliative care pharmacist influence the appropriateness and safety of medicine use in this patient population, there is also likely to be an associated cost saving.…”

“…This model refers to all medicine-related costs. The model was established to evaluate other pharmacist-led services in Northern Ireland and is linked to the Eadon intervention ranking scale [25,26]. Each Eadon-graded intervention can be assigned an associated cost avoidance as illustrated in Table 2.…”

A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

“…More than 10 years ago, the Royal Pharmaceutical Society of Great Britain outlined how pharmacists could contribute to IC services [28]. Whilst there remains a lack of involvement from the community pharmacy sector of the profession, there have been emerging examples of innovative models of clinical pharmacist-led care pathways under development in England [29] and NI [30]. This study suggests that the most pertinent barrier to CP involvement is the existing workload that CPs currently face.…”