I recently sat at a meeting discussing a ‘medicines optimisation’ project around opiate use. Listening to the project I could imagine how the Chief Pharmacist might view the project. He first supported the phrase medicines optimisation and told everyone how important it was. he said it was different from Pharmaceutical Care and Medicines Management and Pharmacists needed to direct their skills differently. If he had been sitting at that meeting I would have sensed his muscles tense, seen his head drop and the look of exasperation on his face. He would, however, have been extremely polite and positive – it is a good job that I don’t have to be.
So – this project ensures that patients are moved to a lower cost (and possibly a more evidence based) opiate and there is an adherence program attached that helps patients to continue taking their medication at regular intervals through providing information. It all links through to PresQipp so it has to be right. It is all electronic and fandangled in its presentation, with pop up boxes and stuff so it has to be advanced and thought leading. It must be medicines optimisation then?
OK – I asked a few questions:
- is there anything that helps clinicians assess patients that may have addictive personality traits and therefore avoid opiates?
- Is there anything that links to community pharmacy and otc opiates?
- Is there anything that helps patients better manage their pain – after all most pain killers will only reduce pain scores by 50 – 75% – there is always something left to manage?
- Is there anything that helps GPs understand comparable doses between different opiates – just how much they are prescribing?
- Is there a maximum normal opiate prescription level set for patients with non-cancer pain to help GPs – the level of additional thought or referral?
- Is there a guide for GPs to help them and the practice team identify patients that might be at risk of addiction?
- Is there a tool to help the GPs ‘diagnose’ one of the 200,000 patients that Public Health England say are addicted to prescribed medicines?
- Is there a referral pathway to specialist services that can help GPs refer patients addicted to opiates to a suitable service provider in a suitable location?
- Is there a service specification in place to manage addiction with a background of severe pain?
Fantastic – we have been given the opportunity to think wider, dig deeper and aim higher with medicines optimisation programs that make a real difference to patients and the NHS and what do we do?
We think up a program that ensures that the same problems exist – yet they are on cheaper drugs, supported by an inappropriate adherence program through sheep dip information.
No wonder ‘medicines optimisation’ gets a bad name.