As part of the AHSN Polypharmacy Programme: getting the balance right the West of England AHSN are supporting health care professionals to identify patients at potential risk from polypharmacy and to support better conversations about medicines.
What is the problem we’re addressing?
We dispense over 1 billion prescription items per year in primary care in England.
Polypharmacy simply means many medicines. As more people live longer with multiple long-term conditions, the number of medicines they often take increases. This can have a significant burden on the person managing and trying to adhere to multiple medicines regimes and can also be harmful.
Studies have shown that that over 50% of older people are prescribed a medicine with more harm than benefit, leading to avoidable morbidity, hospitalisation and mortality. In England in February 2022 there were 876,317 people on 10 or more medicines and 349,653 were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital. Polypharmacy adds preventable cost to the healthcare system and diminishes quality of care for the patient. The most deprived areas tend to have the most issues around polypharmacy, also making this a health inequality issue.
Most of the harm from polypharmacy is preventable.
The National Overprescribing Review (NOR) Good for you, good for us, good for everybody (September 2021) led by Dr Keith Ridge, former Chief Pharmaceutical Officer for England, found that overprescribing is a serious problem in health systems internationally that has grown dramatically over the last 25 years. It identifies two main causes: systemic and cultural. The response to the NOR report is now an NHS England programme.
The NOR sets out 20 cross-system recommendations to be led by a range of NHS and affiliate organisations – the Polypharmacy programme directly supports the delivery, and potential acceleration, of recommendations 8, 16, 17 and 18 into operational practice.
What are the outcomes we are trying to achieve?
Successful delivery of the programme within the West of England will result in:
- From August 2022, a regional Polypharmacy Community of Practice, with members working to address the system-wide challenges of problematic polypharmacy in our geography.
- Routine use of the NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients for a shared decision-making Structured Medication Review.
- Increased confidence amongst the region’s primary care prescribing workforce to safely stop medicines identified to be inappropriate or unnecessary.
- A change in patient expectations – to anticipate having a shared decision-making conversation about their medicines regularly, especially as they get older.
- A contribution to the evidence base around how to help patients to feel more empowered to open up about their medicines issues.
- A contribution to the evidence base around how to tackle problematic polypharmacy.
How will we do this?
The programme is based across three pillars which are supported by a West of England Community of Practice:
Pillar 1: Population Health Management
Using data (NHS BSA Polypharmacy Comparators) to understand Primary Care Network risks and identify patients for prioritisation for a Structured Medication Review.
Pillar 2: Education & Training
Investing in clinical leaders – AHSN Polypharmacy Clinical Leads and expert Polypharmacy Trainers and delivery of local Polypharmacy Action Learning Sets (ALSs) to upskill the primary care workforce to be more confident about stopping unnecessary medicines. The ALS model was originally developed and piloted by Wessex AHSN and supported by Health Education England (HEE).
Pillar 3: Public Behaviour Change
Local testing and evaluation of public-facing initiatives to change public perceptions of prescribing and encourage patients to open up about medicine concerns and expectations.
To understand more about the programme and its ambitions. read the blog ‘getting the balance right on polypharmacy’ from Amy Semple, national Programme Manager and Clinical Lead, Clare Howard.
Polypharmacy: understanding the data webinars
The national Polypharmacy programme is encouraging routine use of the NHSBSA Polypharmacy Comparators to assess patients in high-risk groups. The NHSBSA Polypharmacy Prescribing Comparators tool is available to all GPs and pharmacists. Watch a recording of the April 2022 webinar.
Additional webinars are being held on 29 September and 15 November – find more details and book your space.
Helping patients take their medicines safely: reasonable adjustments
Outside of our polypharmacy work we have created a suite of a free resources to help patients take their medicines safely. These resources focus on improving understanding of the range of, and process for selecting, reasonable adjustments for patients who may be encountering challenges with taking multiple medicines. Resources include a video, decision tree poster and assessment form for use by healthcare professionals. We have also created a short video for patients, carers and families.
Additional resources and information are available from the AHSN Network’s Polypharmacy webpage.
If you have any questions about our Polypharmacy programme, or would like to join our community of practice, please contact Chris Learoyd, Senior Project Manager.