Page 180 - Hospital Authority Convention 2018

Parallel Sessions
HOSPITAL AUTHORITY CONVENTION 2018

PS7.1 Facing the Challenges in Primary Care 13:15 Convention Hall B

Optimising Prescribing in Primary Care in the Face of Multimorbidity and Polypharmacy
Guthrie B
Population Health Sciences Division, University of Dundee, United Kingdom
Multimorbidity is increasingly common because populations are rapidly ageing in many countries, and because better
healthcare has improved survival from acute conditions. Polypharmacy is also increasingly common, partly driven by clinical
guidelines that typically make “whole population” recommendations for treatment which are individually rational but often
cumulatively irrational in someone with multiple long-term conditions. Health services in most countries are dominated
by specialist care which is often poorly suited to optimise prescribing in people with multimorbidity. Balancing benefits
and risks of treatment in people with multimorbidity and polypharmacy is difficult because research commonly excludes
this population, particularly clinical trials of treatment effectiveness. This presentation will describe the epidemiology of
multimorbidity and polypharmacy, the problems this poses guideline developers and clinicians, and an approach to care
drawing on the UK National Institute for Health and Care Effectiveness Multimorbidity clinical guideline.

PS7.2 Facing the Challenges in Primary Care 13:15 Convention Hall B

Bringing Health and Social Care together to Improve Health and Wellbeing
Wittenberg R
Personal Social Service Research Unit, London School of Economics and Political Science, UK
Many countries have been seeking to improve links between healthcare and social care. Care systems and definitions of
Tuesday, 8 May 2018 services concerned with helping people with personal care tasks so that they can live as independently as possible. In the UK
services differ between countries, but the fundamental issue is similar. The challenge is to promote coordinated care across
the spectrum of services concerned with the diagnosis, treatment and continuing management of health conditions and

we refer to the latter as social care.
There are two main reasons why bringing health and social care closer together is a policy priority. First, the wellbeing of
service users who require both health and social care is best served if the care they receive is well co-ordinated and person-
centred to meet their specific needs holistically rather than centred on the way the system is organised. Second, there is a
strong belief that coordinated services are more efficient, especially in preventing or reducing need for long-term care and in
reducing the number of avoidable hospital admissions and delayed hospital discharges.

There are several challenges to bringing health and social care closer. They may include: differences in formal accountability
for healthcare and for social care, especially where responsibilities are divided between different agencies; funding systems
which give healthcare agencies an incentive to shift costs to social care and vice versa; differences in professional culture
and ethos between staff working in healthcare and social care.

A number of approaches can be adopted to address these challenges. Some relate to high level organisational issues around
the planning and financing of services and others relate to frontline issues concerning the delivery of care to individuals.
They span a range from improved dialogue through joint planning, joint funding and joint commissioning to fully integrated
services.

The evidence on what works to achieve more cost-effective care systems through closer links between services is limited.
There is a need for better evidence to inform policy on this topic.

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