Consultant Pharmacist Case Management of Older People in Intermediate Care: a New Innovative Model

Abstract

Rationale, Aims and Objectives: In 2011, ‘Transforming Your Care’ outlined the remodelling of Health and Social Care in Northern Ireland (HSCNI) UK, specifically recommending better integration of hospital and community services for older people. This work aimed to evaluate consultant pharmacist case management for older patients admitted from acute to intermediate care continuing back into the community setting, given the importance of such a transition to person-centered healthcare. Method: On transfer to intermediate care, the consultant pharmacist determined the Medication Appropriateness Index (MAI) for each drug prescribed. Individualised pharmaceutical care plans were implemented with clinical interventions recorded and graded using Eadon criteria. Cost savings resulting from interventions which prevent medication errors/Adverse Drug Events (ADEs) have been estimated using the model as described by the University of Sheffield School of Health and Related Research (ScHARR); these were applied. Drugs stopped/started were costed using the NHS dictionary of medicines and devices (dm+d). Case management continued via communication with GPs and/or community pharmacists and post-discharge patient telephone calls/home visits. Results: Three hundred and fifty-five patients had 3674 drugs assessed for medication appropriateness; both individual and total drug MAI scores on admission to and discharge from intermediate care, were significantly reduced (Wilcoxon signed rank test, p<0.001, n=355). An average of 2.5 clinical interventions per patient were made, with 84% being self-graded as Eadon ≥ Grade 4 (significant interventions resulting in improved care standards). Clinical interventions yielded potential savings of £63-144k pa whilst annual drug cost savings were £68k. Conclusion: This project demonstrated consultant pharmacist case management results in both cost savings and more appropriate prescribing with safer, seamless and more person-centered care.