Supporting older people to manage their medicines at home

Sofia Bibi In Blogs, Safe Use of Medicines

Supporting older people to manage their medicines at home

According to the National Health Service (NHS) in England by age 80, one-third of England’s population takes eight or more medicines daily. The complexity of managing polypharmacy in England is compounded by management of varying daily doses, coordinating multiple specialists, and monitoring health outcomes. The World Health Organization reports that unsafe medicine practices and errors cost £38 billion annually worldwide, with the UK alone facing costs of £237.4 million (WHO, 2017). Older patients are particularly vulnerable to medication-related complications. Research shows that those taking multiple medicines with complex regimens are more likely to experience hospital admissions and serious complications. The risk of inappropriate polypharmacy – where patients take medicines that are no longer needed or cause adverse reactions – increases with age and regimen complexity.

The RESI-Med project, funded by the National Institute of Health Research (NIHR), and led by Dr Giorgia Previdoli and Professor Beth Fylan, has developed a set of resources called “I Manage My Meds” to support people aged 65+ taking five or more medicines (https://imanagemymeds.org/). The study followed a three-step research approach; 1) evidence review, 2) in-depth interviews, 3) a Co-design process utilising Experience-based co-design (EBCD). The toolkit wasn’t created in isolation by healthcare professionals – it was co-designed with those who understand the challenges best: older patients and their family members and enabled the study to produce priorities for its development. The ‘I Manage My Meds’ toolkit is structured around five essential components:

Icons for the 5 essential components

The ‘I Manage My Meds’ toolkit has recently been included in the Royal Pharmaceutical Society’s website (https://www.rpharms.com/resources/repeat-prescribing-toolkit/patient-partnership-agreement) as part of the new GP repeat prescribing toolkit for resources about patient roles and responsibilities. This integration means that GPs and pharmacists can now provide consistent, evidence-based support to patients managing multiple medications. A study assessing the acceptability of the ‘I manage my meds’ resources and how this can be culturally adapted for differing populations is currently ongoing. The inclusion of the ‘I Manage My Meds’ toolkit into a nationally recognised GP prescribing tool demonstrates how patient-centred research can lead to practical healthcare solutions.

Ed Breckin

PSTRC In Blogs, Digital Innovation, Patient safety

Modelling winter pressures at the NHS-R conference

A conference report by Tom Lawton

Simulating the processes of a hospital can help us foresee challenges to which we can proactively respond. The Digital Innovation theme is working on simulations of how patients flow through the hospital to improve foresight relating to increased patient pressures, like what might be expected from the current COVID-19 virus. Our colleague, Tom Lawton, presented his work at a conference of analysts and statisticians associated with the National Health Service (NHS).

Who are the NHS-R community?

The NHS-R community is a network of NHS staff that use the R programming language to do healthcare analysis. The second NHS-R conference was a sell-out event, twice as large as 2018’s inaugural event, and represents an excellent opportunity for the community to come together and share ideas.

What is the ‘Winter Pressures’ project about?

The Winter Pressures project, supported by the Health Foundation, presents a novel data-driven modelling technique to simulate a virtual hospital. As patient-safety specialists, we are using state-of-the-art simulation techniques to improve our understanding of what might contribute to winter pressures, and hopefully uncover potential mitigations. What we learn from this work has implications for how we model patient flow in general, which could help us make informed preparations for events such as the COVID-19 outbreak.

How can simulation contribute to patient safety?

The more we know about what might happen, the better we can plan the best care. Simulation modelling can be used to safely test out scenarios/decisions and ideas to help alleviate unwanted circumstances, like the pressures caused by spikes in admissions. Modelling allows us to test even the strangest ideas without ever putting a patient at risk by making changes in a virtual hospital rather than a real one.

You can try something similar by playing the 1997 computer game Theme Hospital (or more recently, Two Point hospital, which I beta tested!). The game simulates a hospital in which your task is to treat patients against the clock. Our Winter Pressures project created a more complicated and specific simulation to understand how patient flow is affected by a variety of interventions.

For example, what happens if we run a “hotel” to assist patients who were clinically well but had stayed for social reasons? What is the effect of expanding the use of the diagnostic virtual ward, whereby patients are able to wait at home but have their investigations prioritised as if they were in the hospital?

– Image sourced from https://i.ytimg.com/vi/KvgifLGujDU/maxresdefault.jpg

How is the Digital Innovation theme making use of simulation for safety?

Our hospital simulation can be scaled up from a single ward to model an entire hospital at once. We have released the computer code in the hope that we can drive further use of this powerful technique in the NHS.

As part of the NHS-R conference, I led two workshops on simulation modelling using r-simmer. These sold out quickly, demonstrating how much interest there is in doing this kind of work in the NHS. We started with a basic model of an Intensive-Care Unit using more traditional techniques and built it up until it was fully data-driven.

It was difficult for those not already versed in R programming and what is known as Discrete Event Simulation. This showed the need for further training in simulation modelling and we are already in discussions about setting up training so more people can learn how to use these powerful techniques.

The importance of sharing for safety

These kinds of conferences are extremely important to allow projects like this to “touch base” with others, and ensure that the outputs are useful both in terms of what is needed in the NHS, and what can drive the state-of-the-art without being too complex to use. They also serve as a great opportunity to promote the benefits of this kind of improvement work, so it can be used across the NHS for patient benefit. Safety is a property of our healthcare systems so it can only be ensured through healthy and effective connection and communication between us all.

How can I get involved?

We in the Digital Innovation theme would like to know what healthcare project ideas you might have that could benefit from event simulation. Let us know in the comment section below.

And don’t forget to tell us how you get on running your own Theme Hospital.

Acknowledgements

The Winter Pressures project is part of the Health Foundation’s Applied Analytics programme. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

PSTRC In Blogs, Digital Innovation

Digital Innovation for Patient Safety, on the international stage

The International Society for Digital health was launched this year and the Digital Innovation theme are intricately involved to contribute the patient-safety perspective.

On the 25^th September 2019 at the University of Leeds, the International Society for Digital Health had its official UK launch. The launch was attended by over 70 international delegates from as far as Indonesia, China, India, the Gulf and neighbouring EU countries. Members of the Digital Innovation theme were not only in attendance but our theme Lead, Owen Johnson, hosted the event; Moreover, Owen is a founding member and part of the society’s Executive Committee.

Leading the way on the international stage

In June 2019, Owen Johnson was invited to speak at the International Society for Digital Health 2019 conference, with a talk entitled “Patient safety: the opportunities and risks of using AI in medical diagnosis and care”. At the event, he spoke about the motivation for a patient-safety agenda in healthcare information technology. In part, the motivation arises from the consequences of a mixture of over-reliance and under-utilisation of automation. It is concerns like these that the Digital Innovation theme are addressing in our Micronarratives project, wherein we are asking how real-time intelligence is created via human sensor networks.

The difficulty in finding the balanced path of appropriate use of IT and artificial intelligence is somewhat explained by the V, and T challenges that Owen spoke about during his invited talk, at the June conference. The V challenge refers to the five Vs of big data:

Volume – How do we safely handle the very large amount of healthcare data being produced?;
Velocity – How do we safely handle the frequency with which healthcare data is updated and made obsolete?;
Variety – How do we safely handle the diversity of data types, formats, and delivery?;
Variability – How do we safely handle the differences in the way healthcare care is generated and used?; and
Value – How do we safely filter and prioritise the best healthcare data?.

The T challenge refers to safely handling the temporal effects of intervening with healthcare information technologies. Work by McLintcok et al. in 2014 showed how rates of coding and prescribing for incentivised conditions suggest anomalous prevalence and incidence during incentivised periods, but tend to reset to baseline values. It can be inferred that the timing of digital healthcare interventions can have anomalous effects with varying transience. These factors are front-and-centre for us in the Digital Innovation theme as we study the design and implementation of clinical decision-support tools (see Very Smart Cancer RATs).

What next for digital innovation of patient safety?

With these challenges in mind, the Digital Innovation theme continue to work in the overlap of digital technology, healthcare service, and safety science. Our member’s involvement in discussions at the international level facilitates collaboration and innovation for the promotion of patient safety in healthcare. The increasing digitisation and automation of society requires us to actively engage with the leading edge of our progress, and to take pre-emptive action to ensure our collective safety and effectiveness.

How can I get involved?

If you would like to keep up to speed or get involved with the International Society for Digital Health, join the LinkedIn open forum at https://www.linkedin.com/groups/10490340/.

You can also apply for membership by checking out http://www.theisdh.org/membership.php.

patient safety