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Healthy Wirral Partners

Optimising medicine reviews as part of a wider population health management approach

Doctor in discussion with patient, looking at tablet device

Population health management strategies have many facets, of which medications management is a key one, due to its potential to improve citizens’ health, reduce medicines wastage and avoid adverse harm from inappropriate medicines use. Healthy Wirral Partners (HWP) had this in mind when they began working on digitally enhancing their structured medication reviews (SMRs) so the benefits could be felt by their population and partners alike.

A group effort to benefit the community

HWP – part of the Cheshire and Merseyside Sustainability Transformation Partnership – worked with clinical pharmacists from local primary care networks (PCNs) to carry out the work of creating an SMR dashboard. This collaboration helped to ease the flow of raw primary, acute, community and mental healthcare data from the frontline to the stage where it could be analysed to ascertain potential benefits for residents in the local area.

Identifying these data sources and any potential issues with data quality was carried out first, to give HWP a foundation of high-quality data for the rest of the design and implementation process. From there, Cerner supported HWP clinical consulting stakeholders in using HealtheAnalytics℠ to manage an increase of SMR volumes and outcomes over time, before academic partner Imperial College helped them to understand the impact of interventions and the opportunities for learning and improvement that lay ahead.

Significant improvements made

The development of the SMR dashboard has enabled HWP to benchmark medicines use at a system-to-person level. This provides primary care network teams with tools like care summary views and individual case finding to deliver SMRs and medicine optimisation interventions.

For pharmacists, this allows them to more readily identify people – such as those who are housebound or in care homes – that have a number of prescriptions, which could increase the likelihood of them needing hospitalisation. Within the SMR dashboard, pharmacists can see their entire drug schedule and identify where there is a need for medication review in the context of the individual’s health and care, potentially reducing their polypharmacy and anti-cholinergic burden risk.

Imperial College London’s service evaluation into the immediate results of SMR implementation found a mean average of 12.83 medications prescribed in the area pre-review fell to 10.28 after four weeks and 9.55 after eight. As well as reducing polypharmacy, the SMR dashboard helps pharmacists make more efficient use of their time.1

Dashboard helped to reduce inappropriate prescribing by over 25% within eight weeks of SMR being carried out

Developed with pharmacists for pharmacists

The value of SMRs has been realised with end users leading dashboard development from start to finish, allowing the focus to stay true throughout the process. Michelle O’Neill, clinical pharmacist within the Brighter Birkenhead PCN, remarks: “The design, development and implementation has involved a lot of dedication, expertise and time from both Cerner and ourselves, but has been thoroughly worth it in seeing the finished product and how it has come to life.”

South Wirral PCN’s clinical pharmacist Rocco Hadland adds: “The SMR dashboard is very useful and makes it very easy to direct the attention to high-risk patients and takes the hassle out of building complicated searches.”

Work on the dashboard is far from complete, however. Its users and the communities they serve can expect further developments in future, as more data is collected and analysed. Michelle O’Neill concludes: “There is ongoing work underway with the tool and I am sure that we will continue to find ways to use it to its full advantage to improve medicines optimisation across the system.”

The impact of digitally enhanced structured medication reviews at HWP has been published as a detailed case study. View the full report here.


1 Imperial College London. August 2021. Service Evaluation, completed as part of a Master’s student dissertation: ‘Mixed-Methods Service Evaluation of the HealtheIntent Dashboard for Supporting Structured Medication Reviews: Assessing the Impact on Patient Outcomes and Exploring Stakeholder Experiences’. London. Imperial College London.
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Client outcomes were achieved in respective settings and are not representative of benefits realised by all clients due to many variables, including solution scope, client capabilities and business and implementation models.