The purpose of this project was to improve medicines optimisation for the management of patients with spasticity or neuropathic pain who attended specialist neuro outpatient clinics at West Midlands Rehabilitation Centre. The secondary purpose was to identify how much input would be required to optimise medication and if this input could be adequately carried out by a Physiotherapist Independent Prescriber. Historically the Consultant (prescriber) would review and make changes to a patient’s medication for managing their spasticity and neuropathic pain. Patients could contact in case of concerns, however, there was usually no medication follow up initiated by the Consultant between clinic appointments. This was due to limitations on Consultant capacity. Follow up clinic appointments could be between 3-12 months depending on the Consultant request. This meant that if there were issues taking the medication, the issue would not be addressed until the patient returned to clinic. Medication reviews following a face to face appointment can be completely adequate with a telephone review. This is because achievement of goals of treatment with medication is primarily identified through subjective assessment. The standard in this project was that all patients who required a medication change in clinic would be reviewed, on time via telephone consultation(s). The time at which the patient would be need to be reviewed would be dependent on the time period in which the prescriber advised the medication change to occur over.
A single Independent Prescriber Physiotherapist reviewed all patients via telephone, who she had seen in clinic, where changes to their oral spasticity/ neuropathic pain medication had been made. This was between July 2018-February 2019. The project was a time limited pilot and carried out in addition to the clinician’s existing workload. The sample size at the end of this period was 60 telephone consultations which equated to 24 patients. Data was collected on an excel spreadsheet.
Results: All 24 patients were followed up on time. Each patient required between 9 and 1 follow up telephone contacts. 20 patients needed more than one telephone contacts post clinic with the mean average being 2.5. The reasons for needing more than one follow up via telephone were identified and themed. Medication was trialed and optimised for 19 out 24 patients. 9 patients achieved their goals of medication and 10 patients did not tolerate the proposed medication.
Conclusion(s): Timely medicines optimisation was much improved for 19 out of 24 patients. Although 5 patients did not have medication optimised, it was their choice not to trial the proposed medication change. These patients had opportunity to talk through their concerns regarding medication and ask questions through a discussion initiated by the Prescriber after the clinic appointment. This allowed the patient sufficient time make an informed decision and be more empowered, therefore demonstrating enhanced quality of care.
Cost and savings
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This project (alongside a project on Independent Physiotherapist led Spasticity clinics) resulted in a business case and appointment of a full time band 7 Independent Prescriber Physiotherapist. This will allow continuation of timely medicines optimisation in this service.
Top three learning points
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