Research reveals evidence supporting a new cost-effective patient-centred service to support patients with long-term conditions
03 April 2018
Exciting new research conducted by the Community Pharmacy Future group (Boots UK, LloydsPharmacy, Rowlands Pharmacy and Well Pharmacy) and academics from the University of East Anglia demonstrates how community pharmacy can support patients with long-term conditions (LTCs) to improve their quality of life and provide cost effective solutions for the NHS.
The healthcare needs of the nation continue to change due to the ageing population and increasing co-morbidity of LTCs. Currently in England, over 15 million people are living with one or more LTC (such as diabetes or asthma) and, for the majority, medicines will be the first line of their treatment.
In the second phase of their award-winning work, the Community Pharmacy Future group have successfully delivered a new Pharmacy Care Plan (PCP) service to a large cohort of patients in West Yorkshire. The service uses validated clinical tools to support patients who have multiple LTCs, including the Patient Activation Measure (PAM®), which assesses the knowledge, skill and confidence a person has in managing their own health and health care. Patients are scored at different activation levels and supported to improve their level of activation. Research suggests that by moving from the lowest activation level to the highest, healthcare costs can be reduced by up to 21%.
Over a 12-month period, 38 community pharmacies, including independent and supermarket pharmacies, supported 378 patients through the PCP service. The evaluation showed that overall statistically significant increases in levels of patient activation (PAM®), self-reported adherence to their medication, and self-reported quality of life were achieved. The health economic analysis results suggest that the service can be considered to be cost effective.
The study and its results show that this new model of care, which has a person-centred approach at its heart, empowers patients to manage their own condition, and supports the NHS self-care agenda. The PCP service focuses on interventions that community pharmacists can deliver using regular discussions with patients when they are collecting prescribed medication. These include tailored coaching, signposting, and self-management guidance aimed at increasing patients’ levels of activation.
The results suggest that for those included in the evaluation, enrolment on the PCP service was associated with an improvement over 12 months in key clinical and process metrics, and would be cost-effective from an NHS perspective:
- 93% of patients who attended the first appointment agreed one or more health goals with the pharmacist. 39.3% of patients who set goals achieved one or more
- Significant improvement in patient activation scores, systolic and diastolic blood pressure, adherence and quality of life
- In the UK, NICE refers to a cost effectiveness threshold value of £20-30k per QALY with an ICER of below £20k being considered value for money. The ICER was estimated to be £8,495 per QALY suggesting that PCP service is a cost-effective solution for the NHS
Commenting on behalf of the group, Clare Kerr, Head of Healthcare Policy and Strategy for Celesio UK said: “The design, delivery and evaluation of this service has grown the ever-increasing evidence base for the value of community pharmacy, which was one of the key goals for this project. Either the full-service package, or elements of it, can easily be integrated into wider primary care models, supporting patients with multiple long-term conditions to become more activated and better able to self-care, improving their potential outcomes and reducing the cost of their care to the system”.
Jane Devenish, NHS Standards and Services Pharmacist at Well, added: “With the NHS under unprecedented pressure to transform, Community Pharmacy Care Plans must become part of the integrated package of care commissioned by the NHS so that each patient gets appropriate support to reach their health goals”.
Dr Michael Twigg, lead author of the paper says “It has been great to work with the Community Pharmacy Future group to develop and evaluate this novel service. The results are very encouraging and we look forward to working closely with industry colleagues to enhance the role of community pharmacy in identifying and addressing public health needs, and supporting wider primary care teams”.
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- The research can be read in full here: http://www.rsap.org/article/S1551-7411(17)30838-0/fulltext
- The Pharmacy Care Plan is an evolution of the two successful support services evaluated in 2013-2014 that evidenced significant improvements in quality of life and medicines adherence, with health economic benefits.
- Full details of the Community Pharmacy Future group can be found here: http://communitypharmacyfuture.org/
- Community Pharmacy Future is supported by a steering group including representatives from NHS England (Bruce Warner, & Deborah Jaines), Department of Health (Jeannette Howe), NHS Employers (Caroline Temmink), PSNC (Gary Warner, Sue Sharpe & Alastair Buxton), Pharmacy Voice (Rob Darracott), NAPC and GP representative (Dr Charles Alessi). The group also had the support of Martin McShane (ex-NHS England National Clinical Director for long term conditions)
- The independent evaluation was carried out by academics at the University of East Anglia.