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Declaring that the NHS is under pressure would hardly draw any surprise glances in a room full of healthcare stakeholders.
Admittedly, the ranking of the major reasons driving this pressure may differ but there is no doubt that for most people, an aging population, increased prevalence of chronic diseases, personnel shortage and a funding level that is not proportional to the demand for healthcare, would feature reasonably high on most lists.
An additional reason that perhaps is not frequently highlighted as a key/potential future contributor to the pressure is the impact of the changing cost of specialist medicines, especially not in the direction that is immediately apparent to many outside of treatment and clinical service implementation teams.
For instance, since 2018, there has been a push for biosimilar uptake in the UK, resulting in growing levels of switching1, with the spending on such medicines reportedly rising from £6.63 billion in 2017 to £9.45 billion in 20232.
This is significant because such medications, which have both clinical and cost-saving benefits for patients and the health system respectively, often require relatively more monitoring by prescribing teams, and thus potentially adding to the pressure on an already stretched workforce.
From Hospital to Community-based care; what’s new?
Care delivery models that make it possible to treat eligible patients outside of hospitals and within the community environment has clear benefits for patients and the NHS, including increased accessibility to care, reduced hospital admissions, as well as better health outcomes and service capacity; all of which are priorities within the NHS.
Clinical Homecare is one obvious example of an alternative model of care delivery that is capable of relieving pressure on the NHS in a significant way.
A recent review of the Clinical Homecare industry by an independent panel of experts from the NHS and beyond argued that although the number of patients receiving some form of Clinical Homecare support is around 600,000, crucially, there could be as many as 6.8 million people who may be eligible for such support.
Shifting that many patients from the hospital to community based support will be a seismic shift for the health sector, with implications for the soaring cost of care and health care professional burnout, and will free up an enormous amount of time for hospital teams.
Importantly however, without some serious technological innovation, it will be difficult to make that jump from 600,000 to 6.8 million and to efficiently triage and onboard this many patients to community-based support, quickly and reliably.
NHS Consultant – “There is a significant increase in the number of patients being referred to our nurse practitioners for biologic therapy. If we are able to provide support to these patients ‘in between appointments’ based on their predicted needs, with the help of external providers, that would be a very good use of resources.“
Introducing AdherePredict
HealthNet Homecare is bringing to market (and a first-of-its-kind in the UK Clinical Homecare space) an AI-based predictive analytics and visualisation platform to be used by secondary care health professionals to support chronic disease patients who are eligible to self-administer their medications out of hospital, and in between routine hospital appointments.
More specifically, AdherePredict utilises machine learning to predict the risk of poor medication adherence, based on patient interactions with their provider, their behavioural patterns, socio economic data, diagnosis data, medication complexity data, prescription pick-up rates etc.
The generated predictive insight will support a proactive implementation of community-based support that is designed to improve adherence. Research studies in different therapy areas have shown that a proactive approach is a more favoured alternative for interventions designed to improve medication adherence3,4. So, things work better if you act early.
Furthermore, the predicted insight from AdherePredict enables the support that is offered to the patient to be tailored to individual patient risk of non-adherence, thus improving their impact potential.
Several authors have opined that interventions that are tailored according to individual patient needs, risk, persona and changing behavioural patterns, have the greatest chance of impacting negative adherence behaviours3-5.
Importantly, the more patients that are able to be supported via these proactive and better-tailored community-based interventions, the more time is freed up within Trusts.
Secondary Care Medicines Optimisation/Lead Homecare Pharmacist – “Providing tailored support for secondary care patients through homecare would be quite innovative, especially if this support is initiated and informed by this [AdherePredict] technology and delivered directly to the patients.“
How could AdherePredict move the needle on NHS pressure?
The capacity argument:
NHS Consultant – “Adherence is such a multifactorial issue which sometimes takes a very simple intervention to get it better and at other times requires complex interventions. However the big bottleneck to tackling this issue is capacity or staffing in hospital.”
Up to 50% of chronic disease patients are thought to be nonadherent to their medication6, often resulting in treatment complications, re-hospitalisation and reduction in quality of life7.
This effect of this on the health system can be further compounded by staffing shortages, not only in primary care and nursing, but also with specialist roles – such shortages limit the capacity to provide ongoing, consistent care for chronic disease patients.
Clinical Homecare is one viable way of relieving the pressure on NHS resources. It is estimated that the equivalent of 15 NHS Trusts worth of day case elective capacity is delivered each year by Clinical Homecare providers in the UK8.
AdherePredict offers great value in this dynamic as, based on the non-adherence risk prediction, it gives NHS stakeholders an indication as to what level of community-based support to refer a patient to and an opportunity to potentially reallocate limited routine hospital appointment slots.
With a one-click referral functionality, it is designed to significantly reduce the admin burden of managing a large number of referrals to community-based support, including for specialist treatments that have additional monitoring requirements.
NHS Consultant – “It would be good to explore the possibility of a pilot project in patients who are transitioning between two biosimilars, to see if there is an opportunity to make this transition safely without a significant increase in resource utilisation. I can see AdherePredict contributing to this.”
The capacity argument:
Identifying cost-saving opportunities in healthcare delivery whilst not compromising on care quality and patient satisfaction is quite the challenge but is the reality we face.
The recent Lord Darzi report following an independent investigation of the NHS in England, highlighted austerity in funding and capital starvation as one of four heavily interrelated challenges facing the NHS9.
Additionally, it has been reported that, when adjusted for a growing and ageing population, NHS England’s budget is due to be 1% lower in 2024/25 compared with the previous year10.
Studies across different health care systems and therapy areas have suggested that chronic disease management in the community setting (including primary care and at home) is associated with capacity benefits for secondary care, cost-savings for the health system and improved clinical outcomes for patients11-13.
Similarly, the annual value delivered to the UK health economy through Clinical Homecare is believed to be approximately £264m8.
We argue that the cost-saving and overall impact of community-based interventions can be enhanced by leveraging AdherePredict in making these interventions more proactive and better tailored to individual patient characteristics.
The identification of patients who are likely to become non-adherent allows early deployment of personalised interventions – by doing this, we increase the chance of preventing the development and/or deterioration of ‘negative adherence behaviours’ later in their treatment journey.
ICB Medicines Optimisation Lead – “Encouraging patient treatment adherence, coupled with educational support, can contribute to long-term sustainability and align with NHS budget considerations because a return on investment could be demonstrated that would lead to sustainable funding of AdherePredict.“
A tailored approach to supporting patients is certainly more cost-effective than a mass targeted approach, because relatively greater investment is made towards the patients with the greatest risks, rather than a blanket high investment for all patients.
Such approach makes these tailored interventions more affordable, not only for Pharma (who sponsor most Clinical Homecare services today) but also for NHS stakeholders who wish to self-fund such services.
Conclusion
Through advanced analytics on predicted adherence trends and by streamlining medication management, the AdherePredict platform can assist healthcare professionals in addressing potential issues proactively, and ultimately improving the overall efficiency, cost-effectiveness and quality of community-based services.
References:
1. BGMA and BBA, “Biosimilars: Supporting a competitive medicines market that widens patient access and saves the NHS money”. British Biosimilars Association Report, August 2023.
2. Rosembert, D.; Twigg, M.; Wright, D. “Patient’s and Consultant’s Views and Perceptions on Switching from an Originator Biologic to Biosimilar Medication: A Qualitative Study”. Pharmacy April 2024; 12(65). https://doi.org/10.3390/pharmacy12020065
3. Patel, T. “Medication nonadherence: Time for a proactive approach by pharmacists.” Canadian pharmacists journal : CPJ = Revue des pharmaciens du Canada : RPC. August 2021; 154(5): 292-296. doi:10.1177/17151635211034216
4. Stuurman-Bieze, A.; Hiddink, E.; van Boven, J.; Vegter, S. “Proactive pharmaceutical care interventions decrease patients’ nonadherence to osteoporosis medication”. Osteoporos Int. June 2014; 25(6):1807-12. doi: 10.1007/s00198-014-2659-8. Epub 2014 Feb 26. PMID: 24570297
5. Malin, B.; Kalganova, T.; Nwokoro, E.; Hinton, J. “Approaches to Improving Medication Adherence Prediction in Chronic Disease Patients,” Int J Adv Life Sci. May 2024;16(1 & 2): 33–43. https:// www.thinkmind.org/articles/lifsci_v16_n12_2024_4.pdf
6. Kleinsinger, Fred. “The Unmet Challenge of Medication Nonadherence.” The Permanente journal. July 2018; 22: 18-033. doi:10.7812/TPP/18-033
7. Jimmy, B.; Jose, J. “Patient medication adherence: measures in daily practice”. Oman Med J. May 2011;26(3):155-9. doi: 10.5001/omj.2011.38.
8. NCHA, “Best Kept Secret: The Value Of Clinical Homecare To The NHS, Patients And Society”. National Clinical Homecare Association Report, July 2024.
9. A Darzi, “Independent investigation of the National Health Service in England”. Open Government Licence Report. September 2024.
10. OHF, “New analysis shows NHS budget squeezed by inflation and population growth”. Open Health Foundation Press Release. March 2024.
11. Dusheiko, M.; Gravelle, H.; Martin.; Rice, N.; Smith, P. “Does better disease management in primary care reduce hospital costs?” Evidence from English primary care. Journal of Health Economics. September 2011, 30, 5. https://doi.org/10.1016/j. jhealeco.2011.08.001
12. Arsenault-Lapierre G, Henein M, Gaid D, Le Berre M, Gore G, Vedel I. “Hospital-at-Home Interventions vs In-Hospital Stay for Patients With Chronic Disease Who Present to the Emergency Department: A Systematic Review and Meta-analysis”. JAMA Netw Open. June 2021;4(6):e2111568. doi:10.1001/ jamanetworkopen.2021.11568
13. Klein, S. “Hospital at Home” Programs Improve Outcomes, Lower Costs But Face Resistance from Providers and Payers”. Improving Health Care Quality. The Commonwealth Fund. March 2023.
14. Zhao, Y., Thomas, S.L., Guthridge, S.L. et al. “Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia’s Northern Territory”. BMC Health Serv Res. October 2014; 14(463). https://doi.org/10.1186/14726963-14-463
