Norfolk

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GOOD PRACTICE CASE STUDY
Medication non-adherence is a significant cost to the NHS. It has been estimated that 50% of patients do not take their medicines as
prescribed.

Many of these patients will require additional treatment as
a direct result.

Research in 2010 by the York Health Economics Consortium and School of Pharmacy (University of London) suggests that non-adherence may cost the NHS £500m a year. Inflating this to 2015/2016 prices implies a cost today of £568m per annum across the UK.

Norfolk County Council Assistive Technology team first starting using Pivotell Automatic Pill Dispensers to improve adherence in
non-compliant patients in 2006. Shortly afterwards, Norfolk Medicines Support started the specialist assessment for the service, as it was
recognised that pharmaceutical input was required.

Since this time, Norfolk have had over 500 patients using the Pivotell dispenser, and currently have just over 200 patients using them.
The main reasons for opting for a Pivotell dispenser are dementia/worsening confusion around medication – often when a standard MDS has already been used and found to no longer be effective. They might also be placed when intentional or accidental overdose is an issue, or when patients simply forget to take their medication without the
continuous prompt – the “irritation factor”. Another common group of patients to use Pivotell dispensers are those with a mental health illness or a learning disability.

The large majority of Pivotell Careousels in Norfolk are filled by the
person’s community pharmacy or dispensing surgery, and they are paid
a filling fee for this. A handful of Pivotells are filled by the person’s
relatives with training from Norfolk Medicines Support Service.

Case Study:

Mr A from Norwich was originally assessed for the use of a Pivotell in November 2014. He was starting to exhibit signs of dementia, and was coping with some ad-hoc support but no formal package of care, which was being considered at the time. After assessment it was decided that Mr A may respond well to using a Pivotell to support his medication
compliance. The prescribed medication ranged from blood pressure, heart, dementia and gout, twice per day. Once he started to take his medication correctly, Mr A improved considerably and the care package was no longer required.

Calculations showed a potential saving of £5,900 for Social Care with the reduction of Mr A’s care package, plus the uncalculated savings to Health Care from better adherence to medication, in the period November 2014 to April 2016.

The cost savings calculated are:
£4.15 (cost of care for 15 minute call) x 2 (calls daily) x 30.4 (days in month) x 18 months = £4,543 vs unit costs of carousel + £234 paid to pharmacy for filling fees.
As one of the medications is for dementia, the improved compliance has likely increased his ability to continue to live independently.
Based on current level of patients using Pivotells, Helen Wilson estimates that Norfolk save over £600,000 annually on social care costs alone (assuming that on average 2 x 15minute care calls are saved) – which would usually be the only option should the carousel not be in place.

Helen Wilson, “Automatic Pill Dispensers are not always the solution, and we do sometimes have people who have inappropriate expectations from a Careousel, but that being said we often try them to avoid a long-term package of care, particularly since the changes to Care Act eligibility.”

Note:
Norfolk has been particularly successful with encouraging Pharmacy Filling of Pivotell dispensers as where there is no family member
available to fill, a Pharmacist is needed to fill the trays. Norfolk Adult Community Services have over 120 suppliers (pharmacies and dispensing surgeries) who have agreed to fill their Pivotells – quite an achievement.
Pivotell supply filler trays to aid filling Pivotell dispensers trays—free of charge to pharmacists.

Norfolk Medicines Support Service contacts:
Helen Wilson, MAPharmT, Medicines Support Service Manager
Teresa Bunton Medicines Support Service Co-ordinator, Norfolk Medi-cines Support Service.

For further information please contact:
Helen Wilson e:helen.wilson@norfolk.gov.uk  @NorfolkMSS

Nicky Green
e:office@pivotell.co.uk  @pivotell

1 Brown, M et al, ‘Medication Adherence: WHO Cares?’, Mayo Clin Pro, 2011; 86(4): 304–314. Availa-ble at: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC3068890/.
2 Clinical Pharmacology and Therapeutics The case for savings in the NHS December 2016 https://www.bps.ac.uk/
1 Brown, M et al, ‘Medication Adherence: WHO Cares?’, Mayo Clin Pro, 2011; 86(4): 304–314. Available at: http://www.ncbi.nlm.nih. gov/pmc/articles/PMC3068890/.
2 Clinical Pharmacology and Therapeutics The case for savings in the NHS December 2016 https://www.bps.ac.uk/

Copyright: Pivotell Ltd

Naidex Awards Nomination 2017

We are delighted to be nominated for the Naidex 2017 Professional Award

The accolade which celebrates a service, technology or product that directly benefits those working in the care, rehab, or independent living industries, making an immeasurable contribution towards the healthcare profession both now and into the future.

The Pivotell/Jointly product combines the latest technology in pill dispensers with the Jointly care coordination app.

It is an innovative collaboration, driven by input from professionals, users
and carers; a tailored response to real insight into the stresses arising from medication management.

Pivotell dispensers are highly effective in helping vulnerable users to remember to take their medication. Users can now link a Pivotell dispenser with Jointly to receive real time alerts including when a dose is
dispensed or missed, storing these alongside a shared calendar, task
list & medication manager to help coordinate responsibilities amongst
those who share the care.

http://www.pivotell.co.uk/Jointly.htm

http://bit.ly/2lLKkjVSource: Naidex Awards

 

 

Innovative pilot in West Midlands proves the case for Pivotell medication dispensers

Medication can both prolong life and enable people to live independently in the Community. However, medication regimes for many people can become complex and overwhelming. Poor medication adherence can erode self-confidence and well-being. Health and social care agencies must intervene and help people at the right time before complex, costly and intensive interventions like hospital admission become necessary. For the individual this requires straightforward and easy to access support. This project has created new pathways between Local Authorities, PCT Clusters and Community Pharmacies.

The Pivotell automatic pill dispenser service has helped people to self-manage their medication. This report outlines both the business case and qualitative data about the experience of people in the West Midlands using the Automated Pill Dispenser service. As Local Authorities and GP’s assume more responsibilities for community based healthcare this work becomes ever more relevant.

We have not yet explored the potential for GP’s to directly prescribe this service. Equally there are areas across the rest of the country who are yet to explore the technology. We hope this report stimulates the reader to think about the art of the possible locally. Our thanks go to NHS West Midlands, and Improvement and Efficiency West Midlands for funding the Project, all of the pilot sites, Pivotell and Andy Jackson – Project Manager from Charter & Plan Ltd.

Since it started in July 2009, the pilot proved the Pivotell pill dispenser to be invaluable in helping people who failed to take their medication properly stick to their prescribed regime. From the survey and anecdotal evidence, it has been proven that the pill dispenser has had a profound effect on their lives; both people who used the dispenser and their carers report gaining more control.

Of those who supplied feedback, an overwhelming 96% agreed the device had reminded them to take their medication, and as a result improved their health and made them more independent.

Many of those local authorities in the West Midlands who took part in the project are still using and providing Pivotell dispensers to those vulnerable adults who would benefit. The cost savings to those LAs were on average£1700 per person per 6 months. An impressive £3,400 per annum per person using a Pivotell.

With the changes to the Care Act in 2016 moving medication management from social to health care – it would be a waste of valuable data if these pilot results were ignored.

http://www.pivotell.co.uk/downloads/WMPDReport.pdf

Theresa May recognises social care crisis – but solution seems far off

written by  on the Guardian Social Care Network

So now we have confirmation that the government is working on a long-term solution to the social care crisis. Or at least “starting internally to look” at the issue, which must be considered progress of some kind.

Those were the words of Theresa May under questioning by senior MPs at the Commons liaison committee, where her answers on social care were extracted as painfully as those on Brexit – the main business of the session – and on which the atmosphere felt almost as strained.

Beyond that we know very little. Asked for assurances that the review would be inclusive of opposition parties, the prime minister made a caustic aside about past experience and offered only an undertaking of full involvement “when there is a decision taken”.

Prompted to say that the review would consider social care in the context of the health and care system as a whole, May seemed to sense a trap and replied that it would not be considering the NHS budget as part of the exercise. It would, she said carefully, be important to “look at health alongside” social care.

And that’s it. Who is carrying out the review, where it is being done and on what timescale must be matters of speculation. Presumably as on Brexit, May does not propose to give us a running commentary.

A personal story. The beginning of Pivotell.

Caroline Milne, Director. A personal story:  January 2001

My mother, a sprightly 74 year old was diagnosed with Parkinsonism and Lewy Body dementia in 2000. Initially she managed very well with a weekly filled dosset box, taking her pills four times per day.

As with many chronic and degenerative illnesses there were many tablets to take, and problems if they were either not taken or taken late. Mum became increasingly anxious and confused about when to take her next pills. She was confused about the time of day, and which section of the dosset box she should open next.

She began to telephone at all hours of the day and night to ask if it was time to take her next pills. Even though a care agency called on her three times a day, they were not always able to be there at the exact time that the pills were due to be taken, which caused a number of panic attacks as she waited for them to arrive.

I began to worry about her overdosing. I found that pills were going missing from the dosset box. Several times she took her pills, had a nap, and woke up after an hour or so later and thought it was the next day, and so took the next morning’s dose. I could see that if this continued she would have to go into care or would end up in hospital.

Everyone began to get very stressed. I had a full time job and couldn’t be with her four times a day, but I could not accept that just because her medication could not be delivered on time she would have to move into a care home. It took me a long time, but eventually I found a supplier who could provide exactly what I was looking for.

When Mum first started to use it I wasn’t sure that she would recognise the alarm or know that she had to tilt the dispenser over to take the pills. It was never a problem – she left it in the hall during the day, and took it to the bedroom at night.  She had a bag to carry it in when she went out to day-care. The staff at day care were delighted with the dispenser as many times she had dropped her dosset box and pills had spilt over the floor. I kept a spare internal cassette tray at my home and filled it up ready to replace her current tray once a week. Having all the pills at my home meant that I knew when to order repeat prescriptions.

January 2005
Mum was still in her own home and maintaining independence. Although there were other problems associated with old age, Parkinsonism and dementia, pills were no longer an issue. The automatic pill dispenser transformed both Mum’s and my life over that 4 years.

July 2006
Mum was no longer able to use the dispenser herself as she needed 24 hour care.

Caroline and mum Elizabeth
Caroline and mum Elizabeth