Norfolk

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/

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