Last Thursday, on the 30th April 2015, the 3rd National Medicines Forum was held in No.6 Kildare Street, Dublin 2 – also known as the Royal College of Physicians of Ireland. Upon walking in the doors of this truly remarkable building, you honestly feel like you’ve stepped back in time – you can feel the depth of history and can imagine the learning that was absorbed by medical practitioners gone by. Ironically this same sense actually ran as a theme for a lot of the day as many of the speakers reflected on past eras to compare to present activities.
As I walked into the great Corrigan Hall, I felt that usual flutter of nerves in my belly, as I started thinking about my own upcoming presentation. As a non-health care professional, I was very aware that I was in the presence of extremely skilled, educated and knowledgeable persons from the medical arena, but thankfully, as soon as the speakers began, I soon became absorbed in the topics being discussed and my fears quickly disappeared (until it was my turn that is!).
Now I realise that if I were to write in detail about each and every presentation that was delivered from this enlightening eight hour forum, I would have a short novel written, so instead, I will just do a quick skim over from my perspective as a patient, on what I felt was an extremely educational and inspirational experience, from beginning to end.
Thinking back to when Dr. Helen Flint, National Lead for Medicines Management [ONMSD], kindly invited me to this event, I remembered my initial reaction upon hearing its title, and I was a little apprehensive about whether I would be able to comprehend all the medical terminology during the day.
But to my surprise, when I heard the chairs, Dr Helen, plus all the other speakers present their findings, I not only understood [99%!] of what was being said, I also found myself relating to nearly all of the drug names, their classes and what they were used for! Upon realising this initially, I was delighted as it meant I wasn’t sitting there clueless – but a split second later, I recognised that in the reality of my life, this of course, was not a good thing at all because I had either taken or given many of these drugs to different family members over the last few years due to all of their different chronic illnesses.
It was after Ms Mary Brosnan’s (Hon President IADNAM) opening remarks and during Professor Michael Barry’s presentation that many of these medication names were mentioned. Amongst other findings, he was able to showcase some possible projected financial savings if a switch from branded medicines to generics were to happen. Now this topic came up again later during the day when GP, Dr Brendan O’Shea and his team, implemented a study which was able to test the reactions of patients when the branded was changed to a generic by their health care professional. While the majority of patients had either no change, and/or positive outcomes, there were patients who were not happy and even some frustrated or angry with the changes made to their drugs, even though they agreed to partake in the study.
As I listened to these outcomes, I couldn’t help but contemplate how I myself would feel if my children’s drugs were changed to save money, especially if the drugs had been working perfectly fine.
I’m sure I would have asked…
Should I change their medications just to save the “health service” money?
Can a price be put on life or well-being?
And so I thought back to earlier in the day when Deputy Head of the National Centre for Pharmacoeconomics (NCPE) Dr Roisín Adams demonstrated the tough job her team have when recommending what drugs should be put on the reimbursement scheme. Dr Roisín told us how they had to use as much evidence as they could find, from across the world, to weigh up the effectiveness of a drug in comparison to its cost. She explained the difficulty in getting good, quality, measurable data and asked us all to participate in making a decision as to whether we would buy in a drug that could add six months extra to a person’s life. We all found it very difficult to make a decision without more information and she demonstrated that one of the important things they needed to learn was what the quality of life for that person would be in that six month term. Obviously so many other factors came into this process, but she spoke in a way that even I could understand – considering I even found it difficult to pronounce the word “Pharmacoeconomics”!
The tough job Dr Roisín had when making these decisions was made even clearer when inspirational patient and advocate for Cystic Fibrosis Ireland, Katie Murphy, spoke about what her peers had to say about a drug that had worked wonders for them. Katie showed us the many testimonials from CF patients who had been affected in the most positive of ways by this miracle drug, noting that this type of “quality” data is what needs to be captured and used, to help the likes of Dr Roisín and her department make more informed decisions.
Now in the last few years, I had heard this term “informed decisions” being bandied about but I had often wondered if everyone knew what it meant. So when Professor Laserina O’Connor, Prof. of Clinical Nursing (MMUH, UCD), came on stage, I immediately took a liking to her as she showcased some of the one-to-one work she had been doing with patients in the community setting. She was able to validate that by understanding the daily life experience of the patient she could then assess the situation realistically and determine best treatment methods for that individual. She also acknowledged the importance of educating the patient, and their family, about their chronic condition and recognised the difficulty they can have in managing medications and treatments on a daily basis.
But we found that another group of people were also affected on a daily basis by medications and treatments – and these were our prescribers. After a warm welcome from Dr Maura Pidgeon, Chief Executive Nursing and Midwifery Board of Ireland; Professor Peter Weedle, School of Pharmacy UCC,was able to showcase his innovative technology to help health care professionals manage medication reconciliation. He spoke about how to “SIN with EASE by KISSing” [an apt analogy you had to be there for!] and continued his presentation by showing us a very funny YouTube clip [watch it here, it really is very funny!] where a psychologist tells his patient who is afraid of being buried alive to just “STOP IT” over and over again.
Now, of course, everyone can take their own message from this video but for me I feel that there can often be a lot of frustration for health professionals when patients don’t change their behaviour, and as a result, they can either continue to just say the same thing to everyone or go into complete reverse and say nothing at all, putting all patients in the one bracket. I think the same goes for health care professionals who also don’t want to change their behaviours when prescribing and so the message in this video goes both ways. But one thing is important for all stakeholders in our health system – education is fundamental. Health care professionals have an extremely difficult job – every day they make decisions about people’s lives – which can be the difference between that person getting better…or the complete opposite.
So when Dr Mary-Jo McAvin, from the National Medicines Information Centre in St. James Hospital spoke about how their service aims to promote the safe, effective and efficient use of medicines for health professionals, I was delighted that they had somewhere to go to help them continually make better decisions. I learned on the day that through their clinical enquiry answering service they provide evidence-based information and advice to healthcare professionals/agencies on all aspects of the therapeutic use of medicines including indications, drug interactions, drug use in pregnancy and lactation. I have to say I really was so glad to know that professionals had such a great “go-to” service for medical evidence!
Evidence I’m sure some of which has had to have come from Dr. Tamasine Grimes, Associate Professor (Pharmacy) TCD & Tallaght Hospital whom presented a variation of possible ways in which to tackle medication issues.
When she told us that more than 8% of emergency department admissions were due to drug related issues I immediately thought to myself, that if for every 100 patients, 8 of them were not in A&E, this could help tackle the huge problem we have of people lying on trolleys for days on end!
Dr. Tamasine demonstrated the importance of collaborative team efforts in hospitals regarding reconciliation and told us that 6% of all discharged in acutes had a potentially severe drug error. She revealed how a study, named PACT [Pharmaceutical Care in Tallaght Hospital] was a collaborative model of pharmaceutical care involving medication reconciliation and review. She told us it was delivered by clinical pharmacists and physicians, at admission and during inpatient care, and at discharge was shown to be protective against potentially severe medication errors in acute medical patients and also improved the quality of prescribing in older patients. She went on to describe their launch of their Zero Harm Initiative just last month, an initiative I’m proud to say, I also enjoyed helping out with.
After her presentation, I got a bit brave and took the microphone to openly commend Dr. Tamasine and the team in Tallaght on their collective approach and hoped that more in the room could take part in trying to disrupt any unhealthy competitive cultures and replace them with collaborative, nationwide initiatives.
On this, Professor Michael Barry closed the day remarking on the innovation and enthusiasm that was shown throughout. As he spoke however, I couldn’t help but think again about his presentation and about how I would feel if my children’s drugs being changed to save money.
And I thought – what if my children were started on generic drugs from the very beginning of their prescription?
Would I be asking these same questions?
So what if prescribers just started giving the newly diagnosed generic drugs to begin with– thus avoiding the upsetting of those already on drugs which are working for them?
I thought of my children’s physiotherapist – if his hours were cut because the HSE had less money due to unnecessary overspending on medications, then my children’s health would be at risk.
And then yes, there would be a price to pay for their well-being.
So maybe if more patients were educated on the implications of the costs of branded drugs versus generics, then we could all actually help our health care professional and health service, by requesting generics ourselves?
And so, happy that I could take so much away from the Forum, I looked around and again thought of the building we were in and how many others, just like myself, had gained insights from inspirational speakers, in this very room. I reflected on how I had felt when I saw the beautiful staircase as I walked in the doors and I recalled Dr Helen Flints presentation, showing us how the role of the nurse had changed a lot in many ways, but not so much, in many more.
Change, of course, will always be a challenge but remember anything can be achieved if we don’t mind who takes the credit. We should strive to change what needs changing, but be smart enough to leave well enough alone.
Much like this big, beautiful building.