Nov 19, 2014 - Samira Ben Omar, Assistant Director, Patient ... management â community pharmacy case study .... inform
PATIENT SELFMANAGEMENT 19 November 2014 St Paul‟s Centre
Hammersmith
Order of events 09.30
Arrival and registration
10.00
House Keeping
Christopher Gamblin, Independent Facilitator
10.05
Opening welcome and vision for the day
Dr Tony Willis, Hammersmith and Fulham Clinical Commissioning Group
10.10
The evidence and context for Self Management including what is happening locally.
Samira Ben Omar, Assistant Director, Patient Experience and Equalities CWHHE CCGs (Central London, West London, Hammersmith & Fulham, Hounslow, Ealing)
10.20
Working in partnership with local people to promote self management – community pharmacy case study
Ash Khan, Senior Pharmacist
10.30 10.40
A patient‟s perspective Facilitator briefing and process
Liz Sanchez Christopher Gamblin
10.45
Session 1 – “What ideas and examples of good practice would you like to share?”
Table discussions
“What would be your top three priorities?” 11.30
Break to collect refreshments and drinks
11.50
Session 2 – “What might some of the barriers be and what would need to change to overcome them?”
Table discussions
12.30
Review
Christopher Gamblin/ Dr Tony Willis
12.45
Close
Dr Tony Willis
2
Welcome
Dr Tony Willis
GP Member, Hammersmith and Fulham
Clinical Commissioning Group Collaborative Clinical Lead for Diabetes,
Central London, West London, Hammersmith and Fulham, Hounslow and Ealing CCGs
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Dr Tony Willis
My roles: •
Diabetes strategy and transformation in the 5 CCGs
•
IT strategy and systems design within North West London
4
Dr Tony Willis
New contract with Primary Care in CWHHE: •
Significant investment as CCGs
•
Up-skilling of primary care
•
Improving quality and outcomes
•
Self-management including collaborative goal setting and care planning at its very core
•
Due to launch Feb-March next year
5
Dr Tony Willis
NW London Care Information Exchange • Significant local investment from CCGs and providers
• Link health records locally • Allow users and carers ability to interact with records
• Support self-management • Allow 2-way communication • Interact with medical devices, apps, etc
6
Dr Tony Willis
Vision for today’s event Your views on what best practice self-management programmes should be like • Key issues • Actions • Opportunities to bring you together to design a model to deliver self-management
You are: • • • •
Service users Carers Community and voluntary workers Health and social care professionals 7
The evidence and context for self-management
Samira Ben Omar Assistant Director,
Patient Experience and Equalities, CWHHE CCGs (Central London, West London, Hammersmith & Fulham, Hounslow, Ealing)
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Samira Ben Omar
What are long term conditions?
Why self-management?
How you can help?
9
Samira Ben Omar
What are long term conditions? Medical conditions that cannot be cured but can be managed through medication and/or therapy: e.g. diabetes, dementia, chronic heart disease (CHD),chronic obstructive pulmonary disease (COPD), arthritis and hypertension. Why self-management? To work in partnership with people with long term conditions so that they can effectively manage their health on a day-to-day basis. How you can help? Work with us today to help identify and identify the best approaches for people in our community. 10
Current self-management and self-care locally Self-management support type
Example
Active, evidence-based, peer-led programmes for generic selfmanagement
Expert Patient Programme (EPP)
Active, evidence-based, peer and clinician-led programmes for condition-specific self-management
MyAction for COPD
Condition or skill-specific workshops and seminars
Recovery College at NWL
Technology-assisted self-monitoring
DaFne or DeSmond for Diabetes
Interactive web-based self-management programmes
Online EPP
Self-care support type
Example
Condition-specific support groups
Local Breath-easy Groups by British Lung Foundation
Befriending services
Local Mind UK Befriending
Health mentors, navigators and community champions
Westway Health Champions, Turning Point Health Mentors
Social support groups and networks
Knit and Natter Earls Court Wellness Centre
Generic self-management and self-care information
**
Condition-specific self-management and self-care information
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**
Self-management services and change needs What are we doing?
How could we improve?
CCGs commission self-management courses, provided in community settings
-
Sign-post to services Adapt programmes to match population need Commission condition-specific programmes Make the care-plan and care-planning process the central connection between services
Health mentors, health trainers, community champions available to help people develop care-plans and to signpost to services
-
Develop trainer, navigator and champion capacity Improve understanding, links and relationships between HCPs and various support services Improve systems to support more integrated and seamless referral pathways and increase local awareness of services Make the care-plan an active tool used to connect services
-
Self-care and self-management programmes delivered by community and voluntary organisations
-
Self-care and self-management information available online and in multiple formats
-
-
-
Build capacity of third-sector to be able to deliver these services to target populations Improve local knowledge of services to enable greater access Improve access to information by connecting information with other services and make it „subscribable‟ depending on need Tailor information to reach hard-to-reach groups 12
Evidence review - why transform selfmanagement? 1 The people who use the services say that they are not good enough… “I want to be involved in decisions about my care – I want to be listened to” “I want access to information to help me make decisions”
Therefore: Care and support need to change to meet the needs of those with long-term conditions
“I want support to understand my condition and confidence to manage – support to self care” “I want to be treated as a whole person and for the NHS to act as one team” “I want joined up, seamless services”
“I want proactive care “
“I do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach” Based on extensive consultation with people with long-term conditions from: Our health, our care, our say: a new 13from people with long term conditions direction for community services - consultation responses
Evidence review - why transform selfmanagement? 2
We have an ageing population who will increasingly live with one or more long-term conditions Long-term conditions adversely effect a person’s health, wellbeing and happiness The current support offered by the NHS is costly and not fit for purpose The Health and Social Care Act – “health and social care providers, where appropriate to provide opportunities for self-management” 14
The co-creating health model What works for self-management
The Health Foundation‘s House of Care model suggests that changes to self-management support services need to happen in parallel…
The person
Commissioning Evidence-Based SelfManagement - Giving people with long term conditions the skills, confidence and support to self-manage.
The professional
Clinician Training - Helping clinicians to develop the skills, knowledge and attitude to support and motivate people with long term conditions.
The organisation
Changing health systems - So that they encourage and facilitate self-management
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Working in partnership
Ash Khan, Senior Pharmacist Community pharmacy’s role in Health and Well-being Healthy Living Pharmacies
16
Community Pharmacy • Over 11,000 community pharmacies in England • 99% of population can get to pharmacy within 20 minutes by car; 96% by walking or using public transport • Estimated 1.8 million visits a day • Average 14 visits per year
• 84% of adults visit a pharmacy at least once a year, 78% for health-related reasons • Most frequent users are females; 89% at least once a year • Those with LTCs or disabilities or living in rural areas are more likely to visit the same pharmacy • Majority (>75%) use same pharmacy all the time
17
Pharmacies in CWHHE
Westminster
93
Kensington & Chelsea
42
Hammersmith & Fulham
40
Hounslow
54
Ealing
72
CWHHE Total
301 18
Pharmacy‟s strengths
19
Making Every Contact Count
Common Ailments
Ongoing adherence support
Medicines Optimisation
Promotion Prevention Protection
Self care & Healthy lifestyle interventions
PATIENT and PUBLIC Initial supply and support
Early detection
Diagnosis & Treatment
20
COMMUNITY PHARMACY’S ROLE IN HEALTH & WELL BEING
21
What is a “Healthy Living Pharmacy”
A nationally recognised concept enabling pharmacies to help reduce health inequalities within the local community, by delivering high quality health and well-being services, promoting health and providing proactive health advice.
23
What distinguishes a Healthy Living Pharmacy?
Consistently delivers broad range of high quality commissioned services
Quality, innovation and productivity Proactive team ethos Has a least one Health Champion Identifiable by the public Achievement of Quality Criteria A quality mark
24
Portsmouth HLPs
Portsmouth PCT in partnership with Hampshire & Isle of Wight Local Pharmaceutical Committee first developed the Health Living Pharmacy Concept in 2009
25
Portsmouth HLP
The foundation criteria for the award of Level 1 HLP status in Portsmouth were:
• Developing the workforce, including having a healthy living champion (formerly health trainer champion) and developing leadership and change management skills • Premises having a suitable environment, consultation room and IT capability • Multidisciplinary engagement working with GPs, PCT and other provider services.
26
Headline findings from Portsmouth • 140% increase in smoking quits from pharmacies compared with the previous year • Over 3500 individuals received brief advice on safe alcohol consumption; 36% were at increasing risk and 10% at high risk from current levels of use • Over 1100 patients with a respiratory condition have been supported i n the effective use of their medicines • 70% of patients with a respiratory condition showed an improvement in the anagement of their condition as a result of the pharmacist ervention. • 126 clients successfully lost weight with more than half achieving a otal weight loss of greater than 5% •.
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m int t
Services that could be commissioned and delivered by HLPs include:
• Stop smoking • Weight management • Management of Long Term Conditions (asthma, diabetes, COPD) • Physical activity • Men‟s health • Minor ailments
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Key question
Can the results seen in Portsmouth be replicated elsewhere with different demography and geography?
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Pathfinder Programme 2011
Dept of Health set up Pathfinder Programme to replicate Portsmouth HLP model • To evaluate the benefits of the HLP model • 163 pharmacies across 15 Primary Care Trusts
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PUBLIC REPORTED EXPERIENCES
31
Public engagement (n = 1034)
Were you comfortable to receive this service in the pharmacy?
99.9%
Were you happy with how you were treated by the pharmacy staff?
99.7%
Do you feel you were provided with enough information by the…
99.6%
Would you recommend this service to others?
98.3%
Before coming in today, had you heard of healthy living pharmacies?
27.0% 0%
20%
32
40%
60%
80%
100%
How would you rate the service provided? (n = 1034)
Excellent
80.6%
Good
17.4%
Ok
1.5%
Poor
0.0% 0%
20%
40%
33
60%
80%
100%
Location where service users would have sought help/advice had this service not been available in the pharmacy, shown as a percentage (n = 1034)
Doctor
60.2%
A&E
1.6%
Walk-in Centre
5.4%
Internet
3.7%
I wouldn't have done anything
21.2%
Other (please state)
1.3% 0%
20% 34
40%
60%
80%
Pathfinder Project Report (April 2013)
“Successful implementation of the HLP concept required considerable commitment over many months, multidisciplinary working, some financial investment and a skilled workforce to proactively deliver health promoting messages and public health services. HLPs have, over time, developed new ways of working, maximising the skill mix within the pharmacy to deliver services to meet local needs. Geography, deprivation, location of pharmacy or type of pharmacy does not seem to affect successful implementation.”
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The Inhaler Technique Improvement Project (South of England)
•
Medicines Use Reviews with people on asthma and COPD medication
•
Pharmacists tested how well people were managing their asthma and COPD
•
Specialist asthma inhaler advice
•
Use of training devices to aid correct technique
•
206 pharmacies
•
5000 reviews
•
Over 800 follow-up reviews monitoring progress
36
The Inhaler Technique Improvement Project (South of England – Aug 2012)
•
40% of asthmatics showed better asthma control
•
55% COPD patients showed symptom improvement
•
emergency admissions data suggests a positive association between the introduction of the project and changes in hospital emergency admissions
•
patients increased their knowledge of respiratory conditions and how to control them better
•
patients developed greater confidence in controlling these conditions and were able to use “simple tools” to aid management of conditions
37
The Chief Medical Officer said …
“HLPs work!” “They improve choice and we must ensure they are embedded in the new NHS” “Inspirational concept!”
Dame Sally Davies 38
A patient‟s perspective
Liz Sanchez
39
Today‟s process
Christopher Gamblin
40
Group session 1
“What ideas and examples of good practice would you like to share?” “What would be your top three priorities?”
41
Group session 2
“What might some of the barriers be and what would need to change to overcome them?”
42
Review and next steps
Christopher Gamblin Dr Tony Willis
43
