Still getting wasted?
Medicines optimisation is beginning to blossom but challenges remain
In these times of escalating demands on NHS resources, and with medicines being the most common therapeutic intervention for patients, we must all do more to help patients, the public and society get the best outcomes and value from them.
Whatever our role, healthcare professionals, managers, patients and the pharmaceutical industry need to work collaboratively to improve the quality of medicines use. From patients receiving insufficient information about their medicines to the vast number of hospital admissions caused by the adverse effects of medicines which could have been prevented, we simply must do better.
In 2012, good practice guidance for all healthcare professionals in England on medicines optimisation was issued by the Royal Pharmaceutical Society and supported by the Royal College of General Practitioners, Royal College of Nursing and NHS England.
This vital document, together with NICE’s own guidance on medicines optimisation, described a compelling partnership between patients and the health professionals that care for them. Important principles were defined that could revolutionise medicines use, ensuring that the right patients get the right choice of medicine, at the right time.
By focussing on patients and their experiences, the goal was to help them improve their outcomes, take their medicines correctly, avoid taking unnecessary medicines, reduce wastage of medicines and improve medicines safety.
But has anything really changed since the principles were launched or are we seeing a continued focus on reducing prescribing costs without broader consideration for the principles and, critically, patient needs?
In my opinion, there has been some progress to embed medicines optimisation as part of a systems-approach, but there is much more that could be done in practice; policy has not reached the coal-face.
If we are going to truly embrace the concept of medicines optimisation and realise the true value medicines bring, then we must move from concept to practice. Whether prescribing, dispensing, administering or taking medicines, there is more work to be done.
As medicines experts, pharmacists have an important leadership role, regardless of their sector, in championing the principles of medicines optimisation. This means delivering outstanding clinical and medicines use reviews, engaging with other healthcare professionals and ensuring the patient is at the centre of any decision-making about their care.
Pharmacists are beginning to embrace the concept in practice, but how do we extend this intra and inter-professionally? The industry is an integral part of the solution, by supporting a collaborative approach and ensuring easily accessible information with an evidence-base that is relevant and practical.
The guidance sees the industry as having ‘a key role to play in medicines optimisation through transparent and value-for-money partnerships with the NHS that help secure better outcomes for patients’.
Let’s unite to make sure this truly works for the benefit of all patients.
Action stations: how medicines optimisation is being embedded
• NHS England is committed to the establishment of four Regional Medicines Optimisation Committees (RMOCs), operating together as part of a single system to eliminate duplication of activities when reviewing evidence.
• Reduction of unwarranted variation and increasing value through medicines optimisation is a crucial element of NHS RightCare’s innovation work.
• Medicines optimisation is a key activity within the Academic Healthcare Science Networks (AHSNs) and the Medicines Optimisation Dashboard has gained traction in identifying best practice and where improvement is needed.
• We are seeing a shift in emphasis from the medicines management focus on product choice and its cost, to maximising patient benefits from the use of medicines; for example, the adoption of direct oral anticoagulant medicines as an alternative to warfarin.
• Community pharmacy is engaged in two key medicines optimisation services – Medicines Use Reviews and New Medicines Service.
• NHS England has launched the clinical pharmacists in GP practice programme committing over £100m of investment to support an extra 1500 clinical pharmacists to work in general practice by 2020/21.