DOMICILIARY RESPIRATORY SCHEME [PILOT] LAUNCH...
Transcript of DOMICILIARY RESPIRATORY SCHEME [PILOT] LAUNCH...
D E R B Y S H I R E L P C A N D N H S S O U T H E R N D E R B Y S H I R E C C G W E D N E S D AY 1 S T M AY
DOMICILIARY RESPIRATORY SCHEME [PILOT] LAUNCH EVENT
WHY RESPIRATORY DISEASE?
• Derby Hospitals Data – April 12 to Feb 13: • 3,138 admissions for respiratory problems • 403 readmissions equivalent to 12.8% • £556,098 – readmission tariff value!
• Hardwick CCG – asthma pilot • Croydon Domiciliary Visiting Service in Croydon • MURs in the home – not just for respiratory patients • 280 MURs completed • 174.1 emergency hospital admissions avoided • £609,350 cost avoidance (£3,500/admission) • LPC encouraging more contractors to sign-up to keep
momentum going
BACKGROUND TO PILOT
• Southern Derbyshire CCG Prescribing Sub-group • Respiratory disease and frail elderly • £40,000 non-recurrent funding [Transformational Funding] • Collaboration with LPC • Build an evidence base for commissioning the service
• Community Pharmacy • Pharmacist-led interventions and support • Improve domiciliary care of patients with respiratory disease • Identify at-risk patients • Improve patient outcomes • Reduce the number of hospitalisations
AGENDA
• 7.10 pm Welcome and Introductions John Sargeant, LPC Chair
• 7.20 pm Frail Elderly Respiratory Pilot Briefing Andrea Smith, Pharmacist and LPC member
• 7.40 pm Respiratory Training Update Anna Murphy, Consultant Respiratory Pharmacist, Glenfield Hospital
• 8.55 pm Medicines Management Considerations Dr. Diane Harri, NHS Southern Derbyshire CCG
• 8.55 pm PharmPerform and Data Capture John Sargeant, LPC Chair
• 9.05 pm Next Steps and Expressions of Interest John Sargeant, LPC Chair
• 9.30 pm Close
TRANSFORMATIONAL
• Level 1 services – NRT, Not Dispensed, MARs, etc • Level 2 services – MURs and EHC • Level 3 services – INR • Domiciliary respiratory scheme: • Must get this right and deliver a professional service • An opportunity to get involved in patient care and work
with other healthcare professionals
• Could be the start of something great, but get it wrong and: • Pharmacy looses credibility • Will be seen as a missed opportunity • Might not be asked again…
DRS PILOT BRIEFING ANDREA SMITH, PHARMACIST
PILOT OVERVIEW
• Community pharmacy teams & domiciliary support • Repeat collection • Delivery services • Compliance aids
• Domiciliary Respiratory Scheme [Pilot] • £40k non-recurrent transformational funding • Develop evidence base for respiratory interventions • Show how pharmacists can make a difference
• Community Pharmacists are ideally placed to: • Review inhaler technique • Provide advice and support to ensure that patients obtain the
maximum clinical benefit from their medicines (tMURs/NMS) • Medicines optimisation
AIMS / OBJECTIVES
• To support patients currently unable to benefit from regular face-to-face contact with their local pharmacist and improve… • Knowledge of medication/condition • Inhaler technique and symptom control
• Improve communications between pharmacists, GPs and other healthcare providers • Manage waste / reduce prescribing costs • Opportunity to demonstrate the value of
community pharmacist interventions
SCOPE
• Current diagnosis of asthma / COPD • Housebound • Patient must be registered with a GP practice in the
Southern Derbyshire CCG • Patient’s GP should agree suitability for the pilot • Patient must give informed written consent • Pharmacist must have a recent (2 years) CRB check • Pharmacist must be MUR accredited • All data must be recorded on the PharmPerform©
database
DRS PATHWAY - ENROLMENT
1. Suitable patient identified 2. Service is explained to the patient (leaflet) 3. Written consent is obtained 4. GP ‘patient approval letter’ completed and sent
to the GP with a copy of the patient consent 5. GP confirms patient eligibility. 6. Pharmacy team contacts the patient:
1. Agrees date and time for the initial visit 2. Patient may wish carer/family to be present
7. Register the patient on PharmPerform©
DRS PATHWAY – VISIT 1
1. Pharmacist visits the patient as agreed. 2. During the visit the MUR process is completed for
ALL MEDICINES 3. Inhaler technique is checked using an In-check
Dial device 4. ACT / CAT / MRC dyspnoea score is recorded 5. Surplus / unwanted medicines are checked and
recorded/removed 6. Discuss on-going support and agree next visit/
contact
DRS PATHWAY – POST VISIT 1
1. Complete respiratory MUR form 2. Complete Medication Care Plan 3. Send a copy of both forms to the GP 4. Supply the patient with a copy of the Medication
Care Plan 5. Transpose all information onto the PharmPerform©
database (retain all paperwork in the pharmacy) 6. Follow-up / liase with GP where appropriate
DRS PATHWAY – MONTHS 2-5
1. Patient is contacted as often as is required (minimum of once per month)
2. During the contact (home visit / telephone call) you will check: • ACT/CAT/MRC score • Discuss medication used • Dispense and deliver medicines (as appropriate) • Provide ongoing advice/support • Up-date care plan where medication changes are made
3. All patient contact must be recorded on PharmPerform©
DRS PATHWAY – FINAL VISIT
1. Repeat of initial visit at month 6 – intervention MUR Post-visit: • Complete paperwork and data entry • Complete evaluation process (feedback form /
questionnaire)
FINANCE
Initial Visit: ~ 1 hour home visit by pharmacist Completion of MUR form + care plan + data entry
£80
(+£28 MUR fee)
Months 2-5 Minimum of once/month contact @ £20/month Care plan to be kept up-to-date Data entry at each stage
£80
Month 6: ~ 1 hour home visit by the pharmacist Completion of MUR form + care plan + data entry
£80
(+ £28 MUR fee)
Post pilot: Completion of patient satisfaction survey / feedback audit
KEY OUTCOMES
• To ensure that housebound patients are better able to manage and understand their medicines (education/ support/ medication care plan)
• To improve inhaler technique • Maximum clinical benefit from their device • Reduce the risk of respiratory related hospital admissions
• To reduce waste/stockpiling • To provide healthy living advice / stop smoking support • To improve communications between healthcare
professionals • To demonstrate the value of CP in domiciliary care.
RESPIRATORY TRAINING UPDATE
ANNA MURPHY, CONSULTANT PHARMACIST
MEDICINES MANAGEMENT CONSIDERATIONS
DR. D IANE HARRIS , SOUTHERN DERBYSHIRE CCG
PHARMPERFORM© JOHN SARGEANT, DERBYSHIRE LPC CHAIRMAN
NEXT STEPS
• Expressions of interest • Fax to LPC at 01246 431897 • LPC to co-ordinate and countersign • Liaise with NHS SD CCG Prescribing Sub-group • Pilot funding restrictions (numbers)
• Pharmacist • Supporting documents • Identify respiratory patients who would benefit • Liaise with patient’s GP as needed
• LPC Website • www.derbyshirelpc.org