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Improving the use of medicines in East Cheshire

East Cheshire’s Neighbourhood Integrated Medicines Optimisation (NIMO) team started as a small pharmacy project three years ago but, following clinical commissioning group financial support, a pharmacy service was developed and carved into this rural region.

NIMO is based at Macclesfield District General Hospital, where it links closely with the consultant-led frailty team and hospital pharmacy department to smooth the transition at discharge and reduce readmissions. Patients are followed up, once back in their own home, to ensure compliance with new, and often changed, medication regimens. Equally, NIMO has a firm foothold within the community teams, including GPs, community nurses, therapies and well-being services to discuss and manage high-risk patients with the aim of minimising their risk of admission to hospital.

Once a referral is received from any healthcare professional, the NIMO team will gain consent from the patient and use the patient’s GP record, hospital discharge and outpatient notes, as well as any relevant blood results, to formulate a plan to optimise their medication regimen. A member of the NIMO team then visits the patient’s own home, or care home, which often reveals a snapshot of a patient’s compliance with their medication. Dosage regimens are simplified, often resulting in a reduction in care calls and drug cost; polypharmacy is addressed by deprescribing redundant medicines; compliance problems are tackled through patient education, and compliance aids and general medication advice are offered to healthcare professionals and patients when needed.

Current figures reveal that NIMO receives 1,500 referrals annually from other healthcare professionals, the majority being from GPs and the hospital discharge team. Of these, 800 patients are visited at home. The remainder are clinically reviewed via telephone, where appropriate. Recent efficiency measures mean that this figure is steadily increasing, month by month. Around 1,300 interventions are made annually and include: dose adjustments, repeat medication stockpile management, initiation or withdrawal of compliance aids, medication supply, inhaler switches, and optimising medicines use in a cost-effective manner. Anecdotally, patient satisfaction is high, and a recent anonymous evaluation questionnaire from GPs disclosed valuable positive feedback and encouraging approval.

NIMO plans to sustain its monthly growth, facilitated by use of mobile devices and by assessment and review of feedback from stakeholders, to further increase the number of patients who could be seen in this geographically dispersed area. While maintaining close contact with the hospital and GP teams, NIMO’s next step is to liaise more with other patient pathways, such as social services and intermediate care. We predict that this will preserve patient independence and improve cost-effectiveness through accelerated discharge, reduction in care calls and delaying the need for care home placements. NIMO will continue to break down the barriers between healthcare services to ensure that patients receive the most benefit from their medication and, ultimately, remain as independent as possible.

We are in the process of gathering data to illustrate the reduction in hospital admissions and cost savings as a result of running this service.

Readers who are interested in finding out more about this service can contact NIMO by email at

John Rushton

Laurelle Wilkinson

Hayley Bailey

Neighbourhood Integrated Medicines Optimisation team

East Cheshire

Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20200639

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