Blog

In this blog, Hadeel Mohamed, a pharmacist and Polypharmacy Clinical Lead at Health Innovation Yorkshire & Humber, discusses the national polypharmacy programme. She explores what we are doing in our region to tackle problematic polypharmacy and improve patient outcomes by making medication management safer.

People are living longer and managing multiple long-term health conditions, which often means the number of medicines they take increases too. This can create a significant burden for patients as they try to manage multiple medicines (polypharmacy) at the same time.  Polypharmacy increases the risk of adverse drug effects, including falls, cognitive impairment, and harmful drug interactions. Sometimes it’s appropriate for patients to take multiple medicines to manage their conditions, so we use the term ‘problematic polypharmacy’ when multiple medicines are prescribed inappropriately and/or the benefit of their use is no longer clear.

The Health Innovation Network’s polypharmacy programme focuses on improving patient outcomes by highlighting the value of Structured Medication Reviews (SMRs) and supporting primary care teams to conduct high quality reviews, ensuring patients get the best out of their medicines. SMRs are a conversation between a patient and their clinician about their medication to ensure what they are taking is still the most appropriate for them. SMRs are also an opportunity for the patient to raise concerns they have, discuss any side effects, and talk about what they want from their medicines. It is important clinicians establish early in the review that while they bring clinical expertise, the patient brings expertise of themselves which is particularly valuable.

There is strong clinical and economic evidence supporting the use of SMRs, however, embedding these in-depth reviews into clinical practice can be challenging. Good quality SMRs take time, yet there are ongoing pressures in general practice which can make accessing longer appointments difficult. Expansion of the primary care workforce since introduction of the Additional Roles Reimbursement Scheme (ARRS) in 2019, also means we have a workforce with varying levels of experience and expertise. The polypharmacy programme addressed this by empowering health and care professionals when conducting a SMR. Clinicians can access resources to support with their medication reviews, involving the wider primary care team, as well as upskilling clinicians so they are confident having conversations about deprescribing and applying principles of shared decision-making, focusing on meaningful interactions.

The polypharmacy programme has been instrumental in supporting frontline primary care staff to improve medication management across our region by increasing the uptake and use of the resources available through the programme. More than 80 clinicians across Yorkshire and Humber have undertaken polypharmacy action learning set training available through this initiative to enhance their knowledge and skills. We have also helped to create a polypharmacy community of practice bringing together over 110 stakeholders from multiple cohort groups including patients, academia, primary and secondary care.

Through the work of this programme, we are aiming to create sustainable change and reduce health inequalities. The programme is helping to put national policy into practice and improve the quality of conversations between clinicians and patients in relation to their medication.

The community of practice helps health and care professionals feel more confident in supporting patients’ engagement in their own care, stop unnecessary medication, and optimise the medication they take. We have also hosted four polypharmacy masterclasses, providing input from local experts and examples of good practice, which were attended by more than 325 clinicians.

As part of the polypharmacy programme, we periodically identify case studies which demonstrate how the programme has influenced clinical practice within our region. An example case study is from Doncaster East Primary care network (PCN) where, following a presentation of the programme and the PCN data, a pharmacist from Dunsville Medical Practice focused on managing patients at risk of Anticholinergic Burden (ACB) during their scheduled SMRs. Within a six-month period the number of patients with an ACB score of six or more had reduced by a third (from 18 to 12). This case study highlights how data can increase awareness and support education and training, leading to sustainable change in conducting SMRs.

Problematic polypharmacy can negatively impact a patient’s health and reduce quality of life, yet it is often entirely preventable. We have worked with clinicians and patients to produce resources that support open and honest conversations from both parties during an SMR, helping to reduce the risk of harm. As recently reported in the Pharmaceutical Journal, an evaluation of two pilot areas implementing the Health Innovation Network’s patient SMR resources in Manchester and Nottingham demonstrated the following benefits:

• PCNs which shared the information resources with patients before their SMR reported that the quality of the consultation had improved as a result, and they were able to increase interventions to address problematic polypharmacy, which add a cost to the healthcare system and diminish quality care for the patient.
• Patients reported that the materials helped them to think about the medication they take before the appointment, and made them more confident in talking about their medication issues. Patients also reported that they appreciated receiving the documents in their first language.
• Nottingham PCN reported an 88% increase in attendance rates for Structured Medication Reviews after using the resources.

You can learn more about SMRs and the use of the patient materials in the videos below, aimed at both patients and primary care teams, and highlighting the importance of patients having these reviews with a healthcare professional.

Structure medication review video to support clinicians

Structure medication review video to support patients

If you would like to find out more about any of our work, please see our  2024 Impact report

You can also find out more about our programme, stay updated on the latest events, and watch the videos and recordings of past masterclasses on our dedicate web page.