Patient, financial and environmental impacts of a Medicines Optimisation in Care Homes (MOCH) service on polypharmacy following structured medication reviews
Authors: Knight C E , Blythin K , Nicholson L , Altman I 
Published: November 2024

Abstract

Introduction
An NHS community trust was commissioned in February 2023 to deliver a MOCH service to about 15,000 care home residents across an Integrated Care System (ICS). Pharmacists in the MOCH service undertake Structured Medication Reviews (SMRs) to reduce inappropriate polypharmacy, working closely with care homes, General Practitioners (GPs) and community pharmacies. Pharmacy technicians undertake medication reviews to reduce low clinical value medicines. A patient-centred approach means medicines are stopped or changed following shared-decision making with the resident, carer or family.

Aim
To find out the impact of the MOCH service on reducing inappropriate polypharmacy, reducing medicines-related harm for residents, and to report financial savings and the environmental impact through reduction of CO2 emissions.

Methods
This service evaluation was approved by the Trust. No ethics approval was required. Quarterly and 6- monthly data sets covering one week reported by the MOCH service in the financial year 2023/2024 were used. These data sets were extrapolated to a full year. This service reported the number of medicines stopped, started and changed over one week of each quarter for SMRs and, pharmacy technicians reported every six months. Cost savings were calculated using the drug tariff based on continued use of medicines for one year. Pharmacists reported reduction in harm from medicines every six months based on a health interventions risk assessment scoring tool, assessing how many residents had potentially avoided moderate to serious harm following a SMR. The carbon savings were calculated based on financial savings from medicines stopped or changed using the DEFRA SIC 2020 Greenhouse Gases emission factor 0.621(kgCO2e/£) for pharmaceuticals1.

Results
In the first year the MOCH service completed SMRs for 11,363 residents (75% of care home residents in the ICS). Around 20,000 medicines for residents were stopped (one to two medicines per resident). Pharmacists predicted moderate to high-risk harm from medicines was reduced in approximately 4,200 residents. The cost savings from medicines stopped or changed was approximately £2.8 million, which translated to carbon savings of 1,773,340 kgCO2e, the equivalent of removing 644 cars from the road for one year.

Discussion and Conclusion
Reducing inappropriate polypharmacy resulted in a reduction of treatment burden, potential harm to residents2 and financial savings. Social impacts include reducing workload for care homes, GPs and community pharmacies, ultimately increasing the capacity of this stretched workforce (less dispensing, reduced risk of error, shorter medicine rounds and more time for residents). The environmental impact goes beyond carbon savings from pharmaceuticals to include reduction in workload, consumables, delivery and cost of waste disposal and prevention of hospital admissions.3
The limitations of this evaluation are that data collected over one week and then extrapolated may not be representative of all the other weeks in terms of cost savings and reduction of harm to residents, however MOCH pharmacists undertake peer reviews of reduction in harms to mitigate this. Costs incurred in making the financial savings were excluded.
As the demographic of older people rises in the next 20 years a medication review is increasingly important to residents, the health economy, workforce, and our environment.

References
1. Sustainable Quality Improvement [Internet] Oxford: The Centre for Sustainable Healthcare; Environmental outcomes-carbonfootprinting for healthcare 2023_v4 (updated 2024 Apr 4; cited 2024 Jun 5) embedded as ‘this document’ Pg 7. Available from: Measuring Impact | Centre for Sustainable Healthcare (susqi.org)
2. Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions (GB) Department of Health and Social Care; 2021 Sep 21 1-83p Available from Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions (publishing.service.gov.uk)
3. Environmental impact report: Medicines optimisation [Internet] (GB) National Institute for Health and Excellence; 2015 Mar 4 (cited 2024 Jun 5) 1-7pages. Available from Medicines-optimisation-sustainability-report.pdf (nice.org.uk)