In many ways, the concepts of population health management and medicines optimisation are inextricably linked. After all, both are posited as central to delivering integrated healthcare, which provides value for money and addresses health inequalities.
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Yet the idea of PHM — using data to drive improvements to a given population’s health and wellbeing, including by tackling inequalities — is often separated from the idea of ensuring that patients are on the best medicines for themselves. An HSJ webinar, run in October in association with Optum, discussed how the two concepts can work in tandem.
Vicki Kong, Havering clinical lead for population health management and clinical lead for Digital First community pharmacy, north east London, argued there is a powerful recent example of what happens when PHM and medicines optimisation work in concert.
“We did it with the covid vaccination campaign. Cast your mind back to the early stages when we had a finite amount of vaccines. That little box turned up, and we wanted to vaccinate the whole population, but we couldn’t, so we had to identify our priority groups. So, we did data-driven targeted outreach.
“Looking back, we had a lot of innovative approaches through collaborative working [in the early part of the pandemic]. It’s now about reigniting that fire.”
The webinar panellists considered whether, for instance, prescribing and other pharmacy data could contribute to PHM’s population segmentation and targeted interventions. And, on the other side of the coin, they explored whether existing PHM projects might help bolster medicines optimisation opportunities.
The consensus, as neatly summarised by Shropshire, Telford and Wrekin Integrated Care Board’s chief pharmacist Minesh Parbat: “I think we [the NHS] really need to create some form of synergy between PHM and medicines optimisation. The two are very much in silos at the moment, I feel, and I think there are some key drivers and enablers to start to move to a space where we are starting to really make an impact.”
Among the most important of those drivers is accurate data, he argued. “The data needs to be robust. It needs to be insightful. It needs to be able to truly enable commissioners to understand the risk to populations and then how medicine fits into that space.”
Peter Milmer has a dual perspective on such matters. He practises as a GP in Devon but is also a clinical product specialist for Optum. The firm focuses on using data to inform better care, including through PHM and medicines optimisation approaches.
“I think there are certain conditions that lend themselves really nicely to PHM,” he told the webinar. “And I think true medicines optimisation could be based around the optimisation of dosing and adherence – and conditions like heart failure, diabetes and hypertension lend themselves really well to that.”
Ultimately, he said, it comes down to helping answer the question “of how we target our limited resource to the patient who will benefit from it most. And if we do analysis at scale, we might find that we discover new things about the way patients respond to medicines and treatments.”
In Shropshire, Telford and Wrekin ICB, work is already underway to explore the use of a specific medication for asthma patients – and to do so with consideration of the sort of social determinant data that is common in PHM approaches.
The project follows on from the National Review of Asthma Deaths, which found that a significant proportion of patients were prescribed more than 12 salbutamol inhalers in the year before they died.
“We have local protocols and policies in place where we’re starting to proactively look at patients to understand the reasons they are needing multiple inhalers,” explained Mr Parbat. “We’re using a population health approach around it: is it because they have got damp in their houses, and do we need to start signposting to the relevant services? Is it that a social prescriber needs to get involved to be able to provide better support?”
Asked what supports this sort of combined medicines optimisation and population health approach, he pointed towards leadership. “We have a pharmacy leadership board within our system, which gives us a system convening opportunity where we can have a discussion around our key priorities and what we’d like to strategise and move forward in.”
In north east London, Ms Kong sees an opportunity for overlapping a national population health-focused approach with medicines optimisation. The T2Day programme focuses on providing better and more targeted care to people between 18 and 39 living with type 2 diabetes. For Ms Kong, a medicines optimisation conversation with a patient “has a big role to play in that”.
This opportunity also speaks to the prevention and early intervention angle which is central to PHM. “If type 2 diabetes is diagnosed later in life, there’s more limited damage you can probably do. But if you have type 2 from a very young age, you’ve got a whole lifetime of hurt if you’re not managing it properly.”
For Dr Milmer, the opportunities for making a difference in outcomes and providing better preventative care are multiple and encouraging. “PHM currently is medicine with a broad sword in some ways,” he said in his concluding remarks as the webinar drew to a close.
“But increasingly, as we get better data — and better at analysing it, better at understanding it — it will become a scalpel. It’ll be personalised health management, and we will get better at the prioritisation piece.
“PHM is the starting point to allow that prioritisation to be done really well, really accurately, based on outcomes and need.”
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