polypharmacy: seeing it through patients' eyes
TRANSCRIPT
Polypharmacy: seeing it through patients’ eyes
Jeremy Taylor, CEO, National VoicesAt The Challenge of Polypharmacy
20 April 2016
• Coalition of 160+ charities• Founded 2008• Championing person centred care, a strong
patient and citizen voice, and services built around people
• Standing up for voluntary organisations and their vital work for people’s health and care
Person centred care:
• See the person, not the illness• Care for me (or my loved one), expertly,
safely, compassionately • Join up your services around me (or my loved
one)• But don’t take over – I need choices, control,
independence; to be involved; to get on with my life
Medicines: what matters to patients?• What is the matter with me? What will happen?• What does this treatment do?• Are there side effects?• What’s the choice?• What’s the best treatment for me?• Can I cope with taking it?• What about when I’m going into hospital?• What about when I’m coming out of hospital?• Is it working?
Jack’s story
Jack is 65 and lives with a number of conditions:• Asthma• Osteoarthritis• Diabetes• Carpal tunnel syndrome• Underactive thyroid• Cancer survivor (with colostomy)• Enlarged prostate• And more besides
What keeps Jack going
• Positivity: a proactive self-manager (but has been depressed in the past)
• Short term goals: eg nights out with friends• Long term goals: studying; travel
What gets Jack down
• “It’s the arthritis, the carpal tunnel and the bladder control…they’re the things that really affect my quality of life”
• “I’ve got four pages of repeat prescriptions, of about
seventeen different items, the trouble is they all get out of sync…so I’m in and out of the GPs ordering repeat prescriptions and picking stuff up from the pharmacy virtually every week.”
• “I had 13 appointments last month. Just as well I’m retired!”
What Jack would like
More coordination, including:
• One person he can go to for help and advice who has an overview of all his conditions
What do other people say?
• a “burden of work” (Salisbury et al)– Understanding– Adhering – Uncoordinated prescription, review of meds– Multiple single pathway driven appts & interventions
• adverse impact on mental health/quality of life• side effects/harms/interactions of medications
themselves• And an issue of equity (multiple conditions &
deprivation)
The burden of work….
“Research shows that for people taking many medications, the effort and attention that goes into understanding and remembering what each is for, getting repeat prescriptions in a timely way (on different schedules), knowing when to take what, and adhering to the various regimes can become the dominant task in self-management (potentially at the expense of focusing on other areas eg diet, exercise, social activity)”Don Redding, director of policy, National Voices 2016
Person centred coordinated care
“I can plan my care with people who work together to understand me and my
carer(s), give me control, and bring together services
to achieve the outcomes important to me.”
I have the Information
I need…
I am supported to achieve my
goals….
The professionals work as a team.
I always know who is coordinating my care
I’m involved as I want to be in
decisions…
I work with my team to agree a
care and support plan…
When I move between settings there is a plan in place….
Tackling the challenge of polypharmacy• Why am I on all these medicines?• Share medicines decisions around my needs, goals and
preferences• Plan holistically for my care and support (not pathway
by pathway)• Support me to self-manage• Join up!• Review my medicines regularly and holistically (not
treatment by treatment)• Doctors and pharmacists (and other professionals),
please work together!
"The starting point for any system of care should be to ask what it takes to lead a good life".
The Generation Strain: Collective solutions to care in an ageing society. McNeil & Hunter IPPR April 2014
Thanks for listening!
Questions?
@NVTweeting@JeremyTaylorNV www.nationalvoices.org.uk