Homecare Flashcards
1
Q
A definition from the Hackett report
A
- A homecare medicine delivery and service canbe described as being one that delivers ongoing medicine supplies and, where necessary, associated care, initiated by the hospital prescriber, direct to the patient’s home with their consent. The purpose of homecare medicine is to improve patient care and choice of their clinical treatment
2
Q
Historical context in the UK
A
- In 1995 the DOH issued purchasing high-tech healthcare homes
- It stated that hospitals and community health providers should create provision to support patients at home
- This referred to a small number of usually housebound patients
- Examples
- CF patients receiving nebulising and IV antibiotics
- Home TPN patients
- Thalassaemia patients receiving IV desferrioxamine infusion
3
Q
Historical context in the UK
A
- Over time pharmaceutical companies began to offer delivery of high cost treatments directly to patients
- A large portion of these were biological medicines
- This was a value added service
- Where injectable agents were being supplied, it could reduce workload for nursing staff and be convient for patients, especially those that had functional impairement
4
Q
Medicines supply chain
A
5
Q
Existing therapeutic areas
A
6
Q
Low technology services
A
- Oral medications for chronic illnesses
- Licensed treatments
- stored at room temp
- E.g. anti-retroviralsfor HIV and treatments for Hep C
7
Q
Medium technology services
A
- Clinical support or testing may be required
- Patient training may be required
- Self-administration with ancillaries
- Refrigerators may need to be supplied
- Special storage
- E.g. pre-filled subcutaneous mAb syringes for rheumatology
8
Q
High technology services
A
- More complex therapies
- IV infusion
- Self-adminstration with advanced techniques
- Compounded aseptic products
- Administration requiring a healthcare professional
- E.g. home IV antibiotics with or without clinical monitoring or home parenteral nutrition
9
Q
Homecare spend
A
10
Q
Historical context in the UK
A
- Unfortunately, by bypassing pharmacy departments and hospital governance systems, regulation was missing
- This proved problematic and led to a number of questions being asked
- Eventually, the DOH commissioned a report
11
Q
The hackett report
A
- In November 2011 ‘Homecare Medicines: Towards a vision for the future’ published
- The report outlined a number of problems within the market and classified them
- As well as making recommendations on what needed to be done within the NHS to improve the situation for the NHS and for patients
12
Q
The Hackett report conclusion
A
- Problems were split into four different themes
- Market problems
- Governac, in NHS trusts and wider market
- Collaboration across organisation, particularly between NHS trusts
- Patient involvement
13
Q
Hackett review and conclusion
A
- Recognised weak contractual, governance and operational control mechanism
- High tech, high cost, non-tariff drugs specific therapeutic areas. VAT scam
- Patient benefit and convenience
- Lack of intergrationwith homecare providers and NHS trusts- No industry standard
- Rapidly expanding market- value of medicine supply provision has increased to over £1bn
- Best value for patients, NHS, and commisioners
- Varied arrangements for order/Invoice processing
14
Q
Hackett review and conclusions (2)
A
- Bypass clinical pharmacy scrutiny- NICE formulary
- Trust chief pharmacists role strengthened
- NHS trusts need strategy and annual plan
- National homecare medicines committee
- Gudance
- Best practice
15
Q
Hackett review and conclusion
A
- Patient rarely involved in monitoring homecare providers alongside trust pharmacists and medical directors
- Patient centred solutions around delivery storage and quality monitoring lacking
- Involving patients more could lead to reduced wastage of medicines
22
Q
Algorithm for homecare supply
A
23
Q
Homecare service overview
A
24
Q
Case study 1 low tech
A
25
Q
Case study 2- mid tech
A
26
Q
Case study 3- High tech
A
