NHS staff from Isle of Wight NHS Primary Care Trust (also known as NHS Isle of Wight), are celebrating recognition as leaders in the management of medicines – an area that has saved lives and money for the Island. The awards were held in front of an audience of over 580 healthcare professionals at the Hilton Hotel, Park Lane on Wednesday 14th September 2011 and were hosted by comedian Alun Cochrane.
At the inaugural national Health Service Journal (HSJ) Efficiency Awards the Island’s innovative programme to improve the use of inhalers for asthma was rewarded with the Efficiency in Medicines Management award sponsored by JAC. In front of an audience of over 500 people from across England and from a short list of seven entries, Alun Cochrane presented the trophy to the Isle of Wight team.
Paul Jerram, Head of Medicines Management, says: “We set out to reduce emergency hospital admissions and deaths, and to reduce both the quantity and cost of medicines prescribed for respiratory conditions. This is national recognition of our success in saving both lives and saving money for the Island.”
The team at NHS Isle of Wight identified that if you could improve effectiveness of inhaler use patients would benefit from better self management of their condition, emergency admissions to hospital would be reduced and the costs for both commissioners and providers of services could be reduced. When used effectively, 20% of the medication in a metered dose inhaler (MDI) reaches the lungs (the other 80% being swallowed), whereas with a poor technique the percentage drops to between 0 and 10%. Thus a patient can be constantly using their inhaler but get no benefit from it.
Paul continued: “We reviewed the techniques used by doctors, nurses and pharmacists who show patients how to use their newly prescribed inhaler. This revealed a low level of performance across the board with only a small number able to demonstrate correct use of the inhaler themselves. We improved the training for staff and patients and the supporting information.”
Within 12 months of the scheme being introduced in 2009 emergency admissions due to asthma had reduced by 50% and deaths by 75%. Prescribing of selective beta-agonists is still falling taking the Island’s spend for bronchodilators (inhalers) to approximately 20% below the national average for this class of drugs. Hospital inpatient costs for asthma-related admissions have fallen by 66% since the project commenced. Asthma UK hails the Isle of Wight as having the lowest hospital admission rate for asthma in the UK, half that of Southampton.
Dr David Turner, GP and clinical lead for the Isle of Wight Clinical Commissioning Group commented: “This is an excellent example of how collaborative working between all areas of the NHS on the Island has improved care for patients and saved the Island money. This innovation has been recognised nationally and other areas have been advised to copy the Isle of Wight.
“The Isle of Wight has a high prevalence of long term respiratory conditions and this was combined with a much higher than average spend on medication for treatment. Despite the higher spend, clinical outcomes were poor, with a greater number of asthma related emergency hospital admissions than expected. These simple interventions have improved inhaler techniques, the management of patient’s condition, decreased the number of admissions and consequently cost to the service.”
Alastair McLellan, Editor of HSJ, commented on the evening: “We have been massively encouraged…by the success of the first year of the awards. We received over 320 entries and shortlisted 84 of them. There were 70 NHS, private and third sector organisations represented on the evening. Every one of them has demonstrated a commitment to achieving efficiency which should inspire the rest of the service. Every one of them should be very proud of what they achieved. Everyone deserves congratulations.”
A series of measures were put in place on the Isle of Wight to make sure staff and all patients were given improved and consistent training for inhalers:
Training the trainers: NHS staff were initially instructed on how to use the inhalers themselves, and then trained to measure a patient’s ability to use their prescribed inhaler, rather than the previous less scientific visual assessment.
Equipping patients: Once properly instructed and able to use their inhaler efficiently, patients were also issued with a training aid for regular use after seeing their doctor, nurse or pharmacist. This was designed to prevent patients slipping back into previous bad habits. This was the first time such aids have been available free of charge from the NHS.
Holistic working: A more collaborative relationship has been implemented with both primary and secondary care staff working closely together, including GPs formally referring patients to their community pharmacist for inhaler technique training.
Sustaining impact: Steps have been taken to ensure a sustained impact -Trainers are being trained again themselves, and a programme has been implemented for nurses, pharmacists and other healthcare staff to pass on good practice to new staff within their individual organisations.
According to Asthma UK, the Isle of Wight standardised admission rates (SAR) for asthma are the lowest in the UK, with an SAR of 52 in 2008/9, having not been listed in the top 23 PCTs in England in the previous report (standardised where 100 would be mean). (Asthma UK figures, released 2009 based on full Hospital Episode Statistics dataset for England).
Reliever therapy (measured by ePACT) showed an immediate drop, and within the first year costs of selective beta agonists fell by 22.7% – a saving greater then seven times the initial investment by the PCT. (measured as NIC/STAR PU – net ingredient cost per specific therapeutic group age–sex prescribing unit) and a decrease against trend of 25.2% in prescription numbers.