3. ďĄ South London project â supporting patients
with diabetes
ďĄ Supporting community pharmacists to
deliver adherence support
ďĄ Key challenges to future care â the
Southwark and Lambeth IntegratedCare
initiative
ďĄ Summary
6. ď Estimated that there are 3.1 million people with diabetes in England. 800,000 of
these are not diagnosed (1)
ď By 2020 an estimated 3.8 million adults, or 8.5% of the adult population, will have
diabetes and by 2030 this is estimated to rise to 4.6 million or 9.5% (1)
ď The NHS in England spends more than ÂŁ2.3 billion a year on inpatient care for
people with diabetes.Thatâs 11% of NHS inpatient care expenditure (2). Length of
hospital stay is 2-3 nights longer than those without diabetes.
ď Anti-diabetes medicines cost the NHS ÂŁ725 million/year.
ď 30 -50% of medicines prescribed for long-term illnesses not taken as directed
ď For diabetes, we can estimate at least ÂŁ200 million/year waste
(1) APHO Diabetes Prevalence Model, http://www.yhpho.org.uk/resource/view.aspx?RID=81090. Last updated 28/09/2010
(2) NHS Diabetes report November 2011. www.diabetes.nhs.uk
7. 0%
10%
20%
30%
40%
50%
60%
%obese
Schools - % Obese Southwark average London average England average
Schools
Reducing UnwarrantedVariation
Fourfold variation in the rate of hospital
admissions for diabetes in London PCTs
Fivefold variation inY6 childhood obesity
rates across primary schools in Southwark
Tenfold national variation in the % of type 2
diabetics receiving all 9 NICE key care processes
Threefold variation in uptake of structured
education across South London with best at 29%
8. ď Key stakeholders from across south London
invited to discuss how community
pharmacists could be more specifically
involved in supporting people with
diabetes.
ď Participants included representatives from
national diabetes organisations, patient
representatives, academics, commissioners
and healthcare professionals.
9. ďĄ Supporting patientsâ use of medicines
ď§ Identifying concerns and facilitating goal setting
ďĄ Screening for undiagnosed diabetes
ď§ Risk assessment using trigger drugs
ďĄ Supporting use of glucose meters and test strips
ďĄ Communication skills to promote inter-
professional working
ďĄ Signposting
ď§ eye and foot checks; access to support groups and
structured education (DESMOND)
10. ââŚIâve been going to the same place for the past 3 years and they
understand my history and if my medication has run out they will
phone me to remind me.â
Patient 3
â...I ring up the pharmacist, supplies are getting a bit low, tell
them what I want...he will ring the surgery and I will go in about 2
days later and itâs all waiting for me. He will do a delivery service
for those who need it.â
Patient 14
11. ďĄ Raise awareness of common beliefs about
illness and treatment held by patients
ďĄ Enhance consultation skills
ď§ Provide systematic approach
ď§ Examples of good behaviours
ďĄ Develop a proactive versus reactive approach
14. ďĄ Increase awareness about adherence and
challenges
ďĄ Underpinned by evidence:
ď§ Perceptions and Practicalities model1
ď§ Focus on consultation skills using validated
framework (MRCF)2
ďĄ Highlights patient-centred approach to better
understand their medicine-taking behaviour
ďĄ Demonstrates good consultation behaviours
which can lead to behaviour change
ď§ Motivational interviewing
1 Horne, R. &Weinman, J. (1999) Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic
physical illness. Journal of Psychosomatic Research, 47 (6), 555â567.
2 Abdel-Tawab R et al (2011). Development and validation of the Medication-RelatedConsultation Framework (MRCF).
Patient Education and Counseling 83 (3): 451-457.
15. Interactive
Videos demonstrate different levels of
effective practice
Work at your own pace
Reflect on your own practice
Techniques explained in full
Rating exercises to reflect on level of practice
Features & Benefits
16. PRE-MODULE ASSESSMENT (Clinical Knowledge)
PART 1:
Assessing and addressing adherence in diabetes
PART 2:
Identifying and consulting with non-adherent patients with diabetes
PART 3:
Using consultation skills to identify and address patient non-adherence
in diabetes
POST-MODULE ASSESSMENT & REFLECTIVE EXERCISES
27. ďĄ Co-morbidities with ageing
ďĄ Engagement of different health care
professionals
ďĄ Silo approaches
ď§ Poor transfer of information
ď§ Lack of consistency in messages
ďĄ Medicines adherence
ď§ Not routinely assessed or documented
ď§ Agreed plan or intervention not documented
ď§ New Medicines Service and MUR a start
28. Citizens will feel that their health is also their responsibility
and will be supported in self management by building
community assets, capabilities and skills.
We will provide the right care in the right place, at the right
time, reliably and proactively by the professional(s), peer
support workers or volunteers most suitable to provide care.
Ensure we are treating the whole person with integrated care
centred around empowered individuals.
Ensure professionals are best able to deliver this new
approach, ensure better professional lives for the staff we are
working with.
This requires behaviour change by all professionals, citizens
and communities.
1.
2.
3.
4.
5.
29. We need to shift the LTC
care paradigm from
people being dependent
recipients of care to
enabling and supporting
people with LTCs to live
independently and
optimally with their
condition.
Doing more of the
same better will not
be enough
Must do better:
⢠LTCs are under-diagnosed
⢠Too many people with LTCs die
prematurely
⢠QOF scores for LTC management are
well below London average in 7 of 17 LTC
diagnoses
The âScissors of Doomâ - Growing demand
with less funding
⢠Population in S&L expected to grow by
18% in next 10 years
⢠Aging population
⢠People live longer with LTCs
⢠Funding for NHS, Public Health and
Social Services is falling well behind
growth in demand
30. Undertaking healthy behaviours
⢠Not smoking, Exercising, Healthy eating, Drinking alcohol in
moderation
Keeping home environment safe
⢠Impaired mobility and physical ability to take care of all activities of
daily living
⢠Cognitive decline with impaired ability to run a household
independently
⢠Epilepsy with frequent seizures and risk of injury
Optimising medicines use
⢠Taking medications as prescribed or knowing how to take PRN
medications
Detecting and addressing risks early
⢠Detecting people at risk and stratification
⢠Early effective interventions
⢠Care management
31. ďĄ Scoping the key issues, problems and
successes
ďĄ Developed medication adherence screener
ď§ Piloted in hepatitis C out-patient clinic
ď§ Adoption byThrombosis Centre (KCH) - focus on
transfer of warfarin patients to NOAC (time in
range <50%)
ď§ CCG backing to use screener in GP cluster.
32. Pilot in 40 patients â over 20% admitted to missed doses in
week before clinic
The majority of patients (70%) had concerns about their
medicines
Frequency (%)
Possible side effects 23 (62)
How the medicines may damage my body in the long term 9 (24)
Taking too many medicines 9 (24)
Whether the medicines will be of any help 4 (11)
Whether their effectiveness will wear off over time 4 (11)
33. ⢠Preliminary results suggest that the screener can be integrated
into routine care to identify non-adherence
⢠Non-adherence appears to be associated with:
⢠Low motivation (as conceptualised by the Modified Morisky
i.e. forgetfulness and carelessness)
⢠Perceptual barriers (only took their medicine when they felt
the need)
⢠Practical barriers (poor planning of medicine-taking
behaviour )
⢠Used by MDT to target inform consultation during clinic visit
34. ďĄ Capture medicines adherence data routinely and
make available to:
ď§ Aid provision of consistent messages
ď§ Facilitate patient self-management
ďĄ Training for all HCPs is key
ďĄ Opportunity within Lambeth and Southwark to
design and test a system for LTC which draws on
expertise of pharmacists
ďĄ Need to measure impact of approach on health
care outcomes/utilisation/satisfaction
A user friendly interface means people are able to navigate around the various components of the programme and see what is coming up and how much is to be completed.
The programme itself has expected benefits such as it is interactive with opportunities for the pharmacists to click, watch videos as well as read content. But it also enables them to reflect on their current practice in dealing with people. The techniques are embedded in the videos provided and pharmacists are then able to reflect further on these as examples of both good and poor practice. Critically for busy pharmacists they can complete the package at their own pace, at the office or at home and they can stop and pick up where they left off. Once finished they print off their own certificate of completion. So letâs take a closer look at what they will experience.
The learning outcomes are clearly explained and easy to achieve in completing the package
A voice over guides the learner through the information throughout the programme.Before viewing the videos, the learner has the opportunity to review the key points with a simple click on each part which again provides a summary in diagram form of the key points to be remembered.
Videos embedded into the programme provide a seamless experience for the learner and once they have viewed the demonstration learners are again given an easy to understand diagram of the issue being disucssed â in this case ambivalence.
Further on, a video shows a consultation and the learner then has the opportunity to provide feedback on the consultation
The learner is able to:Rate how effective the pharmacist established a therapeutic relationship with patient. Add their own comments in the free text box (optional)