A Quality Improvement project by CNWL’s Sexual and Reproductive Health Services successfully increased the numbers of its HIV patients agreeing to receive their medication at home or through a local pharmacy (Boots).
Use of homecare not only reduces the cost of medication to HIV services and commissioners but offers more choice to patients in how they receive their medication with the option to have medication delivered to home, work or their local Boots pharmacy (which has longer opening hours than the in-clinic pharmacy).
The aim was to increase the number of HIV positive patients newly registering for a home care provider by 500 by April 2019. This meant increasing the number of HIV patients on homecare from an average of 7.5 new patients to 15 new patients per week in a 12 month period.
Medications delivered to patients via a delivery pharmacy, which count as a community-based pharmacy, do not attract VAT.
Delivery of medication to patients takes the pressure off existing in-house pharmacy services helping them to see the patients who want to collect medication inhouse to have a shorter waiting time.
Receiving medication at home also reduces the impact on patients who would otherwise have little need to visit the clinic.
A driver diagram broke down some of the primary and secondary reasons what would best encourage patients to sign up to home delivery and resulted in a number of change ideas.
These ideas were honed in PDSA ramps and were introduced to the service:
- Posters in waiting informing patients of potential for home delivery of medications
- Leaflets handed to patients by clinicians acting as prompts also for a discussion around the subject
- Regular emails from clinic lead to remind prescribers to consider home delivery options with patients
- Published ‘league tables’ of number of new patients to home care per physician.
The target of 500 was exceeded with an additional 760 patients signed up to home delivery of medications by January 2019.
Consultant in HIV Medicine, Dr Alastair Teague, said: “We’ve seen good evidence of sustained improvement and a change in culture achieved regarding awareness of home delivery and increase in its use where appropriate.
“As there are a finite no of patients the rate of sign up cannot be maintained but the numbers of new patients signed up over time has been maintained with only a few needing to come off home delivery for clinical or personal reasons.