This novel approach involves people reviewing their treatments, care and medicines in a 3/4 hour session with two health professionals.
We keep no notes and concentrate on providing the people with their own notes in the form of a written list of things to check out.
We also give advice on trusted sources of information, and on questions to ask their doctors. We ensure people are aware of their rights under the NHS Constitution and the (not so well known) NICE ‘Kindness’ Guidelines.
Benefits identified to date include improved adherence with medicines; improved quality of life; reduced unnecessary medicines; identification and actions on previously unreported patient safety issues; a potential reduction in ‘bouncing’ referrals, less missing information and fewer unnecessary contacts with services.
Because our partnership approach encourages people to trust us, we can discuss whether or not the medicines prescribed are actually being taken (after all 50% of all of us don’t take medicines as prescribed). This can include if any medicines are borrowed, use of any herbal medicines etc., dietary supplements, over the counter medicines, any which have been stopped but the doctor doesn’t know this or any which are bought over the internet, and we can give advice on this. The most important thing being that people share this information with the professionals and care providers they see.
We don’t take a position on any approach if it’s safe and it works (backed up here by our own experience). Our pilot has shown that this service tackles three key areas: 1
1 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 meds. 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.
2 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’. This increased trust and openness seems to be because we always deliver these reviews as part of larger project led by users of services, so by the time we see people they have built up a degree of trust in the process. Of course it helps greatly that we do not keep any notes, instead giving the action plan directly to the person we are seeing.
3 Thirdly, we’re finding some unexpected patient safety benefits. We’re learning that, as a result of the way the sessions are carried out, some people feel able to share information on their situation 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.
Developing an evidence base. The average score at the beginning of the course was 41.1 and afterwards the average was 47.46. A difference of 3 to 8 points is considered meaningful, demonstrating that ‘mental wellbeing improved over the course of the project’.
Our study showed an increase of 6.3 points. N= 30. Time period covered Jan to March 2016.
Reference: Using WEMWBS to measure the impact of your work on mental wellbeing: A practice-based user guide (2015) NHS Scotland. WWW: http://www.healthscotland.com/documents/6074.aspx (accessed 3/4/2016).
Some testimonials: ‘I’ve made a plan for the pain with my Dr, using the info and help given…’ Attendee Nov 2015.
‘You should listen to those guys. You will learn something’ April Attendee 2015.