What was the aim of the project?
The care home pharmacist service undertook clinical medication reviews of care home residents, working in partnership with GPs and community services. The aims were to:
- optimise individual patient medication
- reduce prescribing costs
- prevent hospital admissions related to medicines
- provide support to care homes around medicines management.
Who was involved in the project?
South Gloucestershire Clinical Commissioning Group (CCG) worked with care homes and GPs including the local GP with a special interest in frailty.
What was the aim of the evaluation?
The evaluation aimed to:
- assess the cost effectiveness of the care home pharmacist service
- understand the types of interventions made by the pharmacists
- discover if the service prevented any hospital admissions
- review stakeholder experience
- understand the role pharmacists play in professional standards support in care homes
- identify learning points.
Who was involved in the evaluation?
Data was collected by the new pharmacists as part of their role. Helen Wilkinson, Deputy Head of Medicines Management at South Gloucestershire CCG followed up with GPs and then analysed the data with support from the CCG Graduate Evaluation Assistant. Templates from the ‘NHS Evaluation Works’ online toolkit were used.
What did they do?
They reviewed data collected at pharmacist visits about what medications had changed (as result of the visit), changes to dose, stopping medications and identifying side effects. GPs and care homes were contacted for feedback and two patient case studies were produced.
What did they find?
Pharmacists visited 30 care homes and reviewed 486 patients as part of the service over a 12 month period. The evaluation identified 1,062 interventions with patients, an average of 2.18 per patient. 75% of patients had an intervention of some sort. The top three interventions by the pharmacists were:
- stopping medication for clinical reasons or because they were not needed
- reducing the quantity of medications (to reduce waste)
- switching medications to more cost-effective options.
This highlighted the service was about de-prescribing more than prescribing. Interventions were also analysed to identify which ones were likley to prevent a hospital admission. Five patients were deemed to have been prevented from a hospital admission saving a projected £12,000 of admission costs. The in-year savings to the prescribing budget in 2016/17 was £98,000 with 12 month recurring savings of £198,000.
Who was the evaluation shared with and why?
The evaluation was shared with the Clinical Operational Executive at South Gloucestershire CCG. The work was also presented at a national pharmacy management conference in November 2016 so has spread informally to other pharmacists. It was also part of a nomination for an Health Services Journal award.
The pharmacist role is continuing and new mobile technology is being developed to support the role. Stronger links are being built with the care home liaison team.
What has changed as a result?
The investment in the pharmacist role in care homes has been justified and so the role can continue to benefit patients, reduce costs and improve professional standards of medicines management in care homes. For example, through consistent recording of times of doses and improved communication between GPs, pharmacy and care home.
Successes and challenges
A key success is the relationships that have been established with stakeholders and especially the GP with a special interest in frailty.
The main challenge was getting care homes to feed back on their views of the service.