So far we have found that over two thirds of the attendees get all they need from the group sessions.
The remainder who see us on an individual basis tend to be people with longstanding problems, multiple-medicines and concerns they have not raised before with any healthcare professionals.
The aim of the optional individual sessions is to allow people the option to lead on their own care through a guided conversation with professionals, providing a chance to discuss options in more detail in a safe and supportive environment.
Benefits:
Firstly, this starts to address is the fact that specialists in different areas of medicine only ever review the medicines they have prescribed. So people end up with a continuation of medicines they don’t need and often medicines which make things worse. By going through this in some detail, led by the person themselves who is free to ‘tell their story’, we are helping them make changes.
Secondly, it helps bring out the things people don’t normally tell their doctors (we all do this). In the jargon this is called ‘intentional non-adherence’. We use motivational interviewing techniques, to build trust and confidence in the process.
Thirdly, we’re finding some unexpected patient safety benefits. We’re learning that, because of the way the sessions are carried out, some people feel able to share information on their medicines and treatments with us that they haven’t previously shared with anyone. On a number of occasions, we have been able to give advice on medicines safety and signpost people to services they need, but had previously either avoided or been unaware of.
Cost savings and patient safety: A thematic analysis of the feedback showed that out of the 140 people who attended the group session, 28 people went on to have an individual session.
In the individual sessions 19 people were given advice on referral pathways; 9 signposted to existing resources (such as Medicines Use Reviews) and trusted source of information; 9 people were recommended to ask for a clinical medicines review, 4 were advised on options for opioid switches and 10 on dosage, side-effects or interactions. This prompted one person to comment: ‘In the support session you listened to me, and helped me work out what I needed to say. I gave the notes to my G.P. who changed my medicines and made the referrals you suggested. I now no longer walk with a stick, and feel a lot better. I thoroughly recommend these sessions’
We provide people with their own notes in the form of a written action plan, which they can share with clinicians. T
his work is listed as a NICE Shared Learning Resource.
We’re looking for partners to carry on this approach, and prove (or disprove) whether this is cost effective. Our pilot work is encouraging.