A triage centre and a medicine delivery and treatment monitoring service for patients with heart disease/ hypertension/diabetes using the NHS App for the NHS -ISSN 2753-8176 (online)

Ana Pedro1

1Gwyntwr1386 Pharmacy, Regus Chester Business Park, Heronsway, Chester, CH49QR, UK.

info@gwyntwr1386.com

Part A – Triage Centre

Gwyntwr1386 Healthcare CIC (a future employee-owned company) is looking forward to set up a triage centre with clinical pharmacists for the NHS which would use PGDs or pharmacist independent prescribing in the area of minor/acute illnesses and the NHS App (fig.1, green, 1-3). These pharmacists would receive calls from patients or chat messages etc and they would solve the problem straight away by prescribing or supplying medicines through PGDs, or just advising or would signpost to GP, dentist, opticians, A&E, ambulances, etc according to the seriousness of the situation. The patients would pay a small subscription fee or a small service consultation charge (some could be exempt if the NHS commissioned this service and/or we get some funding through donations to our CIC). If something was prescribed then our pharmacy hub would send the medicines to the patient. Our pharmacy hub would be associated with different GP surgeries which would work as spoke within the hub and spoke model. This triage center would be based at our pharmacy: www.gwyntwr1386.com. Our main client would be the NHS (GP surgeries, A&E services, ambulances, etc). The patients also would be able to return medication through this system (fig. 1) The outcomes of the proposed NHS triage centre will be measured by comparing a group of 18 patients using the proposed NHS Triage center with a group of 18 patients using the standard treatment NHS111 system. We will ascertain if our new system is truly less costly and more efficient as compared with the traditional system (fig. 1)

Part B – Medicine delivery and monitoring service

There is a high prevalence of diabetes and it continues to increase. The adherence to oral antidiabetics ranges from 36% to 93% (1). Moreover, improving the adherence to treatment in diabetes patients will lead to a better glycaemic control and could in the long-term reduce the incidence of micro- and macrovascular complications associated with diabetes (2,3). Also, most MCA (medicine-compliance aids) patients are elderly and suffer of combined cardiovascular disease including diabetes (4).

Gwyntwr1386 Healthcare CIC, intends to hire clinical pharmacists to provide a new, online clinical delivery and treatment monitoring service for the NHS, which will be coupled to the NHS App, based on digital medication adherence packaging such as blister-packs pill bottles, pre-filled syringes and monitoring POC devices such as the Free Libre Sensor and smart blood pressure monitors. The digital medication adherence packaging will record the time, date and location when a dose is removed or taken and will be coupled with a POC continuous monitoring devices such as Free Libre Sensor and smart blood pressure monitors (fig.1) .

This system, will improve quality of life and contribute to the observance of treatments as well as the continuous measure of parameters such as glucose levels and blood pressure, saving time and money in what concerns obtaining clinical data analysis results which will be necessary for clinicians to make decisions about treatment and also assuring the correct and adjusted medication is taken properly (fig.1). Also, it will help to find out when it is necessary to arrange a new face to face appointments with Doctors or other healthcare professionals. This development is logistically robust as the the blister-pack technology is currently already in use within NHS (4). The continuous glucose monitoring is based also on technology that has been tested for use including at the NHS (5-7). Blood pressure monitors have also been offered to the population by the NHS (8). We would like to ascertain the feasibility of this e-system in terms of likely patient benefits. For this reason, the outcomes of treatment (fidelity (9), adherence (10) and acceptability (11), efficacy (12), adverse reactions (13), costs (14)) will be measured by comparing a group of 18 patients using the the e-system with a group of 18 patients receiving the standard treatment (treated with the drugs and standard glucose and blood pressure meters). We will ascertain if our new system is truly less costly compared with the traditional system. Moreover, after this e-system is set up, we aim to develop this same service for other chronic diseases as well as for infectious diseases and for oncologic diseases as well as for emergency situations and to any patient who gets registered with a GP surgery whether has an illness or not.

Both parts A and B would be integrated with the NHS App as shown in fig.1.

REFERENCES

1. Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care 2004, 27:1218-1224.

2. Dailey GE III: Improving oral pharmacologic treatment and management of type 2 diabetes. Manag Care 2004, 13:41-47.

3. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS: Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care 2008, 14:71-75

4. Pedro A. “The use of Multi-compartment Compliance Aids (MCAs) in Pharmacies in England and North Wales”. Preprints. doi 10.20944/preprints202007.0541.v1. July 2020

5. https://www.freestyle.abbott/uk-en/products/freestyle-libre-2.html

6. Vervloet et al. BMC Health Services Research 2011, 11:5

7.Vervloet et al. Int J Med Inform 2012, 594-604

8. https://www.england.nhs.uk/2021/11/nhs-offers-home-blood-pressure-checks-to-save-thousands-of-lives/

9.The Assessment, Monitoring, and Enhancement of Treatment Fidelity In Public Health Clinical Trials. Borreli B. J Public Health Dent. 2011 WINTER; 71(s1): S52–S63.

10.Barriers and facilitators to medication adherence: a qualitative study with general practitioners. Kvarnström K, Airaksinen M, Liira H.BMJ Open. 2018 Jan 23;8(1):e015332. doi: 10.1136/bmjopen-2016-015332.

11.Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. Mandeep Sekhon, Martin Cartwright, Jill J Francis. BMC Health Serv Res. 2017 Jan 26;17(1):88.

12.A Primer on Effectiveness and Efficacy Trials. Amit G Singal, Peter D R Higgins, and Akbar K Waljee. Clin Transl Gastroenterol. 2014 Jan; 5(1): e45.

13.Eliciting adverse effects data from participants in clinical trials. Elizabeth N Allen, Clare IR Chandler, Nyaradzo Mandimika, Cordelia Leisegang, Karen Barnes. Cochrane Systematic Review – Methodology, Version published: 16 January 2018

14.Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost-minimisation analysis. Austen El-Osta, Maria Woringer, Elena Pizzo, Talitha Verhoef, Claire Dickie, Melody Z Ni, Jeremy R Huddy, Michael Soljak, George B Hanna, Azeem MajeedBMJ Open. 2017; 7(8): e015494.

15. Pedro A (2022). “An E-Medicine Delivery and Treatment Monitoring Service For Patients With Heart Disease In The NHS” - Project proposal ISSN 2753-8176 (online) (DOI:10.13140/RG.2.2.34395.03360)

16. Pedro A (2024).An E-Medicine Delivery and Treatment Monitoring Service For Patients With Type-2 Diabetes In The NHS - Project proposal ((ISSN 2753-8176 (online)