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Optimise – Service Evaluation of an Innovative Service to Reduce Prescription Medication Dependence
- Soraya Mayet, Zuzana Drozdova, Sarah Easingwood, Kate Nadin, Merran Morgan, Eleanor Blakeston, Dave Reade
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S133
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- Article
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- You have access Access
- Open access
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Aims
Opioids, gabapentinoids, benzodiazepines and z-drugs cause dependence, increase deaths, and have been found to be ineffective for long-term conditions. Despite the risks, these are some of the most prescribed medications. In response, we worked with commissioners to develop an innovative service ‘Optimise’ for the treatment of prescription medication dependence. Optimise aimed to support patients to reduce and stop prescribed medications that can cause dependence when the medications were not clinically recommended.
MethodsOptimise started in February 2020 in the North of United Kingdom. The service was staffed by two addiction nurses, with support from the Addictions Consultant Psychiatrist and team leaders. GP's identified suitable patients, gained consent to refer and referred to Optimise. Patients received a harm information and service letter, after which they were offered telephone triage, assessment, and ongoing psycho-social support. The nurses worked closely with GP's and advised on prescribed medication reduction plans. Due to COVID-19, most patients had telephone appointments.
Humber Teaching NHS FT service evaluation approval. All referrals were reviewed retrospectively to assess demographics and outcomes. Friends and family (FFT) test offered to patients. Data were analysed via excel.
ResultsTwenty-one GPs referred 258 patients (Feb 20-Oct 22). Most were female (70%) and all white; mean age 56 (21-97) years. Patients were prescribed opioids (92%), gabapentinoids (32%), benzodiazepines (9%), and/or zopiclone (7%). The most common opioid prescribed was morphine, followed by oxycodone and fentanyl. A letter was sent to 254 patients referred, 217 patients attended telephone triage, with 148 agreed to work with Optimise. Of 145 (56% of referred patients) who attended the assessment, 86% gradually stopped (n=24; 17%) or reduced (n=100;69%) their prescribed medications.
Patient feedback:
Eighteen patients completed FFT and stated the service was good or very good.
‘The nurse was informative and has helped me reduce my medications when I thought I wouldn't be able to.’
‘Listened to my concerns and gave me time before changing my medication.’
ConclusionOptimise is an innovative service that has helped patients of all ages to reduce and stop prescribed opioids, benzodiazepines, gabapentinoids and zopiclone, that can cause dependence, increase overdose risks, and were not clinically recommended. These patients had previously not been able to reduce or stop these medications. It is positive that with two nurses there has been such a great impact with excellent outcomes and good patient engagement. Commissioners should look at funding similar services to enhance the support for patients who are prescribed medications that can cause dependence.
10 - UN sustainability goals and social value: local authority perspectives
- Edited by Adrian Bonner, University of Stirling
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- Book:
- COVID-19 and Social Determinants of Health
- Published by:
- Bristol University Press
- Published online:
- 18 January 2024
- Print publication:
- 20 January 2023, pp 192-209
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Summary
Introduction
In this chapter the concepts of social value reviewed by Liddle in Chapter 8 will be developed to include environmental value and, in particular, the wicked issue of climate change. Liddle critically reviews the literature on public and social value, and the historical development of these ideas in relation to New Public Management and the quantification of social value in relation to the relative importance that people place on changes experienced in their lives from a wellbeing perspective. Using a combination of accounting and economic measures, the Chartered Institute of Public Finance and Accountancy and Deloitte have used international accounting standards and UN Sustainable Goals.
Social value and environmental value is defined with reference to the different approaches through the lens of various organisations and, where focusing on environmental value in this chapter, it covers its impact at an international, national, regional and local level in particular with reference to climate change strategies and with references to housing. More detailed discussion of housing will be presented in Chapter 11, and youth employment in Chapter 12.
Global climate change concern
Concern and debate relating to climate change is not new. While provisions on climate change were adopted in the ‘Declaration of the United Nations Conference’ on 16 June 1972 in Stockholm, it was not until much later that decisive action could be said to have occurred. The size and scale of the problem was noted at the time within a statement released on 16 July 1992 by the Union of Concerned Scientists, a group of leading US scientists dedicated to raising issues around climate change. In its press release it noted that ‘human beings and the natural world are on a collision course’ and went on to outline specific areas of environmental concern, namely, the atmosphere, water resources, oceans, soil, forests and living species Union of Concerned Scientists, 1992).
The United Nations Framework Convention on Climate Change
In May 1992, underlining the need for a Framework Convention on Climate Change (FCCC), the UN stated that ‘human activities have been substantially increasing the atmospheric concentrations of greenhouse gases, that these increases enhance the natural greenhouse effect, and that this will result on average in an additional warming of the Earth’s surface and atmosphere and may adversely affect natural ecosystems and humankind’ (UN, 1992).