A look at the nuts and bolts of an award-winning project to improve the quality of life of older adults in Northern Ireland.
“Big dreams start small. All you have to do is go for it,” says Deirdre McCloskey, highlighting the philosophy behind a flourishing Northern Ireland initiative, with community pharmacy at its heart.
Deirdre is Project Coordinator for Mid & East Antrim Agewell Partnership (MEAAP), the lead partner for the IMPACTAgewell project, which won the Community Pharmacy Collaborative Working Award at the 2019 Northern Ireland Healthcare Awards.
What is the project?
“Its vision,” says Deirdre, “is to improve the quality of life for older people by providing person-centred services that puts their wellbeing and social needs on a par with their medical needs.”
IMPACTAgewell, which launched in June 2017 and had been in development since December 2015, is based on a community-led approach to health and wellbeing and was successful in its bid to secure an award of almost £1m from the Dunhill Medical Trust in 2016.
£1m IMPACTAgewell secured an award of almost £1m from the Dunhill Medical Trust in October 2016
Community pharmacist Stephen Slaine helped design and implement the programme. His involvement with Integrated Care Partnerships (ICPs) in Northern Ireland fed into the project’s success. Stephen says: “ICPs comprise people from trust, primary care, community and voluntary sector, ambulance services, patient representatives and the borough council, looking after a population of 100,000.”
MEAAP led the establishment of this innovative model of community-led care, and, notes Stephen, “with the support of an IMPACTAgewell project officer, GPs, six Primary Care and Community Together (PACT) community pharmacists and health trust staff, older people are supported and empowered to manage their long-term conditions and access neighbourhood community or voluntary activities.”
How does it work?
“Following a referral from any of the partners,” explains Stephen, “the project officer visits an older person at home. The officer outlines factors affecting health and wellbeing: a warm home; suitable transport; visiting family and friends; or building confidence to question healthcare professionals (HCPs) delivering their care. Over a six-month period, the partners in the 11 locality hubs learn not only an older person’s concerns, but also the contributions of partner colleagues towards meeting an older person’s social and medical needs.”
The average age of participants is 80 years. ‘The age range is 66 to 93 years,’ adds Deirdre, ‘60% live alone, with 27% receiving domiciliary care support, and each person has an average of 11 repeat prescriptions.’
“In the first year,” explains Stephen, “there were 72 hub meetings, involving over 100 HCPs receiving 391 referrals. Our target was 300 referrals.” By 31 March 2018, says Stephen, 106 older people had ongoing active support; 68 had completed the programme, 26 referrals were pending and 191 were rejected because 71% self-reported “enough support”; 9% did not meet the criteria; 6% self-reported “felt too unwell”; and 14% other reasons.
Winner of the Community Pharmacy Collaborative Working Award at the 2019 Northern Ireland Healthcare Awards
Anne McAlister, NPA Representation Manager for Northern Ireland, says that community pharmacists “are making a positive difference to the health and wellbeing of the project’s participants and are advocating for the contribution that community-based pharmacists can make to multidisciplinary working.”
PACT is an innovative new social enterprise, established in 2014 and delivering targeted local patient-centred public health initiatives in partnership with GP federations, health trusts, community and voluntary organisations and councils.
What role do PACT pharmacists play? Stephen says: “They attend strategy and training meetings and monthly multidisciplinary hub meetings. At these, they identify and discuss pharmaceutical interventions appropriate for the service user and any Health and Social Care Board community pharmacy services which may suit, including managing medicines, medicines use reviews and the smoking cessation and minor ailments schemes.” PACT pharmacists also work with the project officer and community pharmacies to ensure that older people receive the appropriate community pharmacy service.
Mairead Conlon is PACT Pharmacist Coordinator for the project and she notes that the six PACT pharmacists are fully involved in the review of each older person participating in the project. “If, through home visits and guided conversations, we identify a need for support related to medications or minor ailments, we contact the older person’s usual community pharmacist to arrange, for example, a medicines review. The wonderful thing about the PACT model,” adds Mairead, “is that the PACT pharmacists working in the hubs are representing all community pharmacists in the locality.”
“Community pharmacists are making a positive difference to the health of the project’s participants”
Stephen looks forward to further success with the project: “We’re continuing to collaborate on our year two interim evaluation report which will identify ‘change over time’ evidence, including a fiscal return on investment, available in October 2019. Thanks to further support and investment, we will be working with SCIE and the New Economics Foundation consulting teams over the coming months to complete an alternative social return on investment analysis of the project.” Further, the community pharmacy contribution to the project is being evaluated over two years with the Regional Medicines Optimisation Information Centre.
Reflecting on the project’s success, Deirdre recalls how the external funding from the Dunhill Medical Trust presented an opportunity “to spend time, sitting as equal partners around the table, whereby we were able to co-design the IMPACTAgewell model. This has proved a key element of our ongoing success, as there is a better level of understanding of the obstacles we all face, and a genuine passion to work together to achieve better outcomes for our community.”
Stephen adds: “It has been a privilege to be involved in such a collaborative project where the pharmacy network is working as part of a primary care multidisciplinary team. There’s a real enthusiasm to support outcomes for older people.”