Abstract
Title
Evaluation of a new regional pathway for Medicines Optimisation in Older People (MOOP) medicines adherence pharmacist optimising medicines in older people referred by Northern Ireland Ambulance Service (NIAS)
Authors & Provenance
PCrawford1; SJohnston1; PGalbraith1; PTennyson1; CDarcy2; CMcGuigan2; KMiller3; JPatterson3; JAgnew4; JMcGennity4; HMcKee5; ACunningham5; CStevenson5; KBloomer6.
- MOOP Pharmacy Medicines Adherence Service, Belfast Health and Social Care Trust
- MOOP Pharmacy Medicines Adherence Service, Western Health and Social Care Trust
- MOOP Pharmacy Medicines Adherence Service, South Eastern Health and Social Care Trust
- MOOP Pharmacy Medicines Adherence Service, Southern Health and Social Care Trust
- MOOP Pharmacy Medicines Adherence Service, Northern Health and Social Care Trust
- Consultant Paramedic Urgent Care, Northern Ireland Ambulance Service
Introduction
The Regional Medicines Optimisation in Older People (MOOP) Medicines Adherence Pharmacy team review medicines for older people at home across Northern Ireland (NI). Northern Ireland Ambulance Service (NIAS) are often the 1st responders to older people at home requiring medical attention, & identify medicines adherence issues, which may lead to Emergency Department presentation and hospitalisation if not addressed.
Method
In July 2023 a new pathway to enable NIAS first responders to refer people ≥65 years for a medicines adherence review was piloted.
Inclusion Criteria- Age ≥65 years
- Medicines adherence issues
- Patient consents to referral
Pharmacist Interventions were graded using the Eadon grading scale1 & ScHARR cost avoidance estimates2,3, which defines costs related to Adverse Drug Events (ADEs) were applied (Table 1).
Results n=12
Reason for referrals by NIAS included older people with multiple unused medicine compliance aids, suboptimal pain management, or confused about their medicines.
Time spent by the pharmacist reviewing patients ranged from 60 to 400 minutes (average 170 minutes per patient). Clinical interventions included blood pressure measurement, deprescribing of inappropriate medicines, optimising pain management, & supply of adherence aids.
Table 1: Cost avoidance2,3 of medicines adherence pharmacist optimising medicines
| Intervention description (Eadon criteria) |
Cost avoidance ScHARR model £ |
Eadon Grade | Number of interventions made by pharmacist (%) n=62 | Cost avoidance £ | |
| Potentially lethal | 1334-2606 | 6 | 0 | 0 | |
| Potentially serious | 877-1824 | 5 | 1 (1.6%) | 877-1824 | |
| Potentially significant | 80-184 | 4 | 60 (96.8%) | 4800-11040 | |
| Minor | 0-7 | 1-3 | 1 (1.6%) | 1-3 | |
|
Total cost avoidance due to adherence pharmacist interventions: £5678-12867
Time spent band 8a pharmacist (12 patients) = 2045 minutes = 34 hours Approx. £26.06 per hour band 8a cost NI Pharmacist band 8a cost = £886.04 for 34 hours
|
|||||
Invest to save: £6.40- £14.52 for every £1 invested.
Conclusion
A collaborative pathway between medicines optimisation in older people pharmacy service and the Northern Ireland Ambulance Service, let to cost effective improvements in medicines optimisation for older people.
References
1.Eadon, H. Assessing the quality of ward pharmacists’ interventions. Int J Pharm Pract. 1992; 1(3): 145-147.
2.Karnon J, Mcintosh A, Dean J et al. 2008. Modelling the expected net benefits of interventions to reduce the burden of medication errors. J Health Serv Res Policy2008; 13: 85-91.
3.Mair A, Scott M, Kirke C. iSimpathy Evaluation Report Edinburgh 2023 ISBN978-1-3999-6298-8.