How technology can improve our approach to medicines optimisation

Resolving common obstacles related to medicines management

Speaking as a former Clinical Commissioning Group medicines management lead, I think two things have become increasingly clear within the NHS over recent years.

The first is that medicines management has an essential role to play in helping save money, reduce inequalities and deliver better results for patients.  The second is that pharmacists, working in partnership with other primary care professionals, have a massive contribution to make — particularly as the NHS grapples with the increasing rates of polypharmacy and associated risk of over-prescribing. Both of these focus on the quality agenda for prescribed medicines.
 

Putting mechanisms in place for better medicines optimisation

What’s less clear is whether the right mechanisms, capabilities and resources are in place to help things along. There’s certainly no lack of ambition in national policy-making — whether it’s through the launch of Pharmacy First, or written into last year’s 16 national priorities for medicines optimisation from NHS England.

But if you speak to frontline pharmacists about their experiences on the ground, as we did last year, you get a sense of the health disparity obstacles that are standing in the way.

A vote of confidence from primary care providers

For starters, relationships within primary care are paramount. I think one of the most encouraging developments we’ve seen in recent years has been a much greater collaboration between pharmacists and other primary care professionals, particularly GPs.

The fact that nearly half of the £839 million spent on Additional Roles Reimbursement Scheme (ARRS) posts from 2019 to 2022 was directed at pharmacists shows the value that Primary Care Networks (PCN) attach to having well-trained professionals available at point of prescribing.

Whether or not you think this has come at a cost to community pharmacy, as some have claimed, that’s a considerable vote of confidence in the potential for clinical pharmacists to make the difference in primary care.

But have we got to the point where this potential is being fully realised? Possibly not. Creating the right level of trust and understanding between professionals takes a lot of time and effort on both sides — and my suspicion is that we’re not quite there yet in many parts of the country.

The same is true in terms of pharmacy having a seat at the table at Integrated Care Board (ICB) level. In some areas, we’re starting to see fruitful conversations, but there’s still a nagging sense that pharmacy hasn’t secured a parity of esteem with other professional voices, or a consistent presence in strategic planning discussions.

Added to this, a lack of access to meaningful data for prioritising and driving decision-making also emerges as a common barrier — and so too does the lack of resource and capacity necessary to get through the sheer volume of work that needs doing.
 

Innovation in technology can support better medicines management 

So could technology help us move things forward? Optum introduces a new clinical support tool: Population360®.

For some time, Optum has been developing a new clinical support tool called Population360, which answers some of the practical challenges preventing ICBs, clinical pharmacists and primary care prescribers from collaborating at scale.

What we’ve developed is a way of helping teams more rapidly understand risk across their entire patient population, making it easier to identify and act on cost-saving opportunities, signs of non-adherence and critical safety issues related to medicines which may put patients at risk.

As a way of managing workflow, it delivers live data on a daily basis, suggesting cost-effective, clinically safe switches and the savings attached to them — which means it offers a much more efficient way of managing priorities for action.

And for clinical safety, it provides different types of alerts, based on a set of clinical rules processed against the patient record, to identify patients with an avoidable medication error. These are not always clear, but the tool helps to identify patients quickly so that prescribing teams can act to reduce harm and prevent hospital admissions. As well as flagging nationally-established PINCER alerts, these clinical rules can also be fully customised to meet local prescribing priorities.

Senior pharmacist, Surinder Kumar, gives his initial perspective

Surinder Kumar, senior pharmacist at Dawley Medical Practice in Telford, has been one of the first to test the new system in practice. 

One of his most striking points is the sheer speed and scale that can be achieved through technology — by tracking and following up on safety alerts, the pharmacy technician at Surinder’s practice could review 16 at-risk patients in 30 minutes using the system. And that can make all the difference at a time when resources are so thinly stretched.

Another advantage is reporting. One of the things often lacking in practice/PCN clinical systems is a useful throughput of data so that teams can see the impact of their actions. Population360 highlights the number of patients, the potential savings, the admission avoidance and the number of safety alerts all in hand.

Having access to this information makes it easier for teams to track progress, determine what is and isn’t working, and then have confident, evidence-based conversations with patients, GPs and other stakeholders about what to do next.
 

Applying technology to population health management principles

Looking ahead, I think one of the exciting (and as yet unfulfilled) areas of development is applying technology and linked data together with population health management (PHM) principles to address inequalities in prescribing practices. That’s certainly what we’re trying to do in our work with Population360.

The number one thing that our technologies can do for prescribers and pharmacists is provide a means of finding patients with specific characteristics. To give one example, you might be interested in reviewing patients that have had a fall recently.

Linking directly into your clinical systems, we can simply add that as a rule within Population360. It then surfaces those patients and presents practice teams with an actionable list of patients to approach.

Being able to filter the available data — systematically and at scale – so that primary care teams can understand and support those cohorts of patients most at risk gives us the chance to make serious inroads into the inequalities we come across every day in our work. That’s where I think technology can be a game-changer.
 

Optum extends invitation to trial the new Population360 tool

In the meantime, Optum is continuing to work with pharmacists, GPs and ICB medicines optimisation teams to refine our products and find new ways of solving problems for primary care. So, if you’re interested in the new Population360 tool for your practice or PCN, then please get in touch via asktopum@optum.com