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Shared decision making

Realistic Prescribing. Shared decision making. The background. Introduction - Dr Scott Jamieson (GP) Case study 1 - Polypharmacy – making decisions together. Dr Alison Clement (AMD & GP)

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Shared decision making

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  1. Realistic Prescribing Shared decision making

  2. The background • Introduction - Dr Scott Jamieson (GP) • Case study 1 - Polypharmacy–making decisions together.Dr Alison Clement (AMD & GP) • Sharing the decision in practice - Aids to supportthe conversation - Arlene Coulson (Lead Clinical Pharmacist) & Fran Benison (Patient and Public Forum for Medicines Representative) • Case study 2 - Sharing the decision in out-patient settings - Lee-Ann McDermott (Specialist Clinical Pharmacist) & Sue Cole (Patient and Public Forum for Medicines Representative)  • Case study 3 - Sharing the decision in an acute setting - Karen Lowdon (Specialist Clinical Pharmacist)

  3. Declarations • MBChB MRCGP DRCOG DRSRH DPD • http://www.whopaysthisdoctor.org/doctor/391 • Full time GP, Practice Quality Lead • OOH Dundee ¼ full-time • GP Rep to NHS Tayside Medicines Advisory Group & Area Drugs & Therapeutics Committee • Angus HSCP Prescribing Lead; Chair NHS Tayside Non-Medicines Advisory Group • RCGP E Scotland Faculty Board; RCGP Scottish Council Rep • RCGP GP Rep to SIGN • RCGP Scotland Executive Officer (Quality Improvement) • University of Cardiff marker - DPD

  4. The collaboration Discussion points with the Panel • Are we doing enough to promote these opportunities? • How can we make all decisions closer to a true choice? • What experiences do we all have? • How do we know we are getting it right? What’s the measurable impact? • What would be ‘Realistic evaluation’?

  5. Shared decision making Optimal patient care Evidence-led Patient led

  6. Uncertainty

  7. Polypharmacy – making decisions together Alison Clement

  8. Brenda (70yrs), previous stroke • 27 tablets daily + 3 creams + 2 eyedrops + 1 liquid laxative • Painkillers, antidepressants, constipation, blood pressure control. • Can’t face another tablet

  9. John (also 70yrs), mini-stroke years ago • Now has metastatic cancer – spread to the bones • Symptoms well controlled under supervision of Macmillan nurse, 8 tablets daily • Just retired, feels well, wants to continue with what is working for him

  10. Andrew (45yrs) stroke aged 41yrs • Came into nursing home and had been told had few months to live due to a tumour • 1 year on and no evidence of any deterioration, 8 tablets daily reduced from 10 • Glad he made the decision to continue his stroke prevention treatments

  11. Sharing the decision in practice - aids to support the conversationArlene Coulson, Lead Clinical Pharmacist Fran Benison, Patient and Public Forum for Medicines

  12. Could these decision aids help to prepare patients?

  13. Benefits Risks

  14. “Right to Ask”

  15. Patient Empowerment

  16. Shared decision making in the out-patient setting:An example from Pharmacist Led Rheumatology Review ClinicsLee Ann McDermott, Specialist Rheumatology Pharmacist

  17. Shared decision making involves: • Encouraging the patient to ask the right questions

  18. Scenario • Patient with rheumatoid arthritis • - treatment needs escalated to try and achieve disease control

  19. Shared decision making in the out-patient setting:Sue Cole, Patient and Public Forum for Medicines and Rheumatology patient

  20. Diagnosed with Rheumatoid Arthritis in 2007 • Given DMARDS to dampen down immune system • Methotrexate & Hydroxchloroquine intolerant • Consultant offered a new biologic as next step.... • 2012 Certolizumab aka Cimzia made dramatic difference • Have to weigh up new symptoms/side effects with being able to lead as active and pain-free life as possible.

  21. Shared decision making in the acute settingKaren Lowdon, Specialist Clinical Pharmacist

  22. Case study 3 • 93 year old lady • P/C dyspnoea and general decline • known CKD, AF & IHD • o/a iron deficient anaemia due to PV bleeding

  23. “Fundamental to the doctor and patient relationship is the requirement that a patient with capacity to decide should be informed about the treatment options open to him or her; the risks and benefits of each option; and be supported to make their choice about which treatment best meets their needs”

  24. The collaboration Discussion points with the Panel • Are we doing enough to promote these opportunities? • How can we make all decisions closer to a true choice? • What experiences do we all have? • How do we know we are getting it right? What’s the measurable impact? • What would be ‘Realistic evaluation’?

  25. Thank you

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