Shared learning database
Type and Title of Submission
Implement shared care prescribing guideline for drugs for dementiaDescription:
Project to identify and overcome the barriers to implementing shared care guidelines for dementia medicines.Category:
ClinicalDoes the submission relate to the general implementation of all NICE guidance?
NoDoes the submission relate to the implementation of a specific piece of NICE guidance?
YesFull title of NICE guidance:
TA111 - Alzheimer's disease - donepezil, galantamine, rivastigmine (review) and memantineCategory(s) that most closely reflects the nature of the submission:
Description of submission
NICE originally issued guidance in 2001 recommending use of acetylcholinesterase inhibitors (AChEIs)for Alzheimer's-type dementia for initiation by a specialist and for continuation by a GP under a shared care prescribing arrangement. Although local specialists were early adopters of NICE recommendation to offer these treatments, local GPs would not agree to implement shared care prescribing arrangements because of clinical and financial concerns. This project set out to identify and overcome the barriers to implementing shared care guidelines for these medicines.Objectives
* Develop a shared care prescribing guideline for acetylcholinesterases * Agree commissioning arrangements to enable implementation of this guideline * Assess impact of implementationContext
Specialists were obliged to provide regular long-term prescriptions for these medicines, which consumed significant resources on behalf of otherwise stable patients. This system also involved large amounts of dispensed medication being posted to around 500 patients/carers/community pharmacists from the hospital pharmacy service at significant clinical risk to patients and financial risk to provider trusts. It resulted in many problems, for example: some patients became harmed by unintended interruption of treatment following admission to acute medical units or when medication was lost; unsafe working practices evolved and there were significant levels of drug wastage.Methods
Between October 2006 and April 2008: 1. A shared care protocol was developed A business case was developed in partnership with a neighbouring provider trust 2. Commissioning arrangements were agreed with local PCTs 3. A database was developed in collaboration with the trust IT department; incorporated into the electronic patient record system; capturing treatment-related clinical data (e.g. MMSE scores) it enables assurance reporting to stakeholders Communications forms were developed to improve the flow of clinical information to GPs 4. Stakeholders were kept informed of developments via local representative committees and bulletins 5. Systems and protocols were put in place to safely manage the transition to shared careResults and evaluation
We monitored outcomes via: 1. Analysis of primary and secondary care prescribing data 2. Review of hospital dispensary workloads 3. Review of the trust clinical incident database 381 patients were transferred to shared care during 2008/9; 96% of requests to GPs for shared care arrangements were accepted. Corresponding hospital prescribing and dispensing rates fell dramatically, freeing up resources for the management of new referrals; primary care prescribing rates rose in line with transfer of patient to shared care arrangements. Patients benefited from closer relationships with their GPs, enhancing GP involvement in their dementia care; GPs benefited from more timely and comprehensive out-patient communications. In line with the projected financial gains, health economy-wide growth in CHEI drug spend fell from 21% in 2006/7 to 5% in 2008/9 following the implementation of the new scheme, releasing NHS resources for the care of more patients No plans to publish at presentKey learning points
That, with careful forward planning, the implementation of shared care prescribing arrangements for large numbers of patients can be managed safely and effectively, ensuring that the projected clinical and financial benefits are realised
|Name:||Mr Tim Donaldson|
|Job Title:||Trust Chief Pharmacist/Associate Director of Medicines Management|
|Organisation:||Northumberland Tyne and Wear NHS Foundation Trust|
|Address:||Department of Pharmacy, St Nicholas Park, Jubilee Road|
|County:||Newcastle Upon Tyne|
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This page was last updated: 21 September 2009