Resources to tackle polypharmacy
Problematic polypharmacy affects a patient’s quality of life and can have a negative impact on their health. It is often entirely preventable. As more people live longer with multiple long-term health conditions, the number of medicines they take often increases. This can create a significant burden for the person trying to manage multiple medicine at the same time, and in some cases, it can cause harm.
In England, the NHS primary care system dispenses over one billion prescriptions every year. In September 2023, there were 993,019 people who received 10 or more medicines of which 402,462 of them were aged 75 or over. This is problematic because:
- a person taking 10 or more medicines is three times more likely to suffer harm.
- 16.5% of unplanned hospital admissions are due to adverse drug reactions (ADRs) and polypharmacy.
- there has been a 53% increase in the number of emergency hospital admissions caused by ADRs.
Structured Medication Reviews
NHS England describes a structured medication review (SMR) as an evidence-based and comprehensive review of a patient’s medication, considering all aspects of their health. In a structured medication review, clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives to taking medicines. The shared decision-making conversation is led by the patient’s individual needs, preferences and circumstances.
NHS England describes the benefits of SMRs for patients taking multiple medication as:
- Improved experience and quality of care by involving patients in the decision-making process and helping them better understand the medicines they take.
- Less risk of harm from medicines (e.g. adverse drug events, side effects, hospitalisation or addiction)
- Better value for local health systems (e.g. reduced medicine waste).
These resources were originally developed through research undertaken by The University of Leeds and The University of Bradford.
The three core principles of this programme
The Health Innovation Network’s national polypharmacy programme in built on three core principles aimed at supporting local systems in addressing problematic polypharmacy.
- Population health management
- Clinician training
- Patient engagement
These three principles are also supported by a Yorkshire and Humber polypharmacy community of practice focusing on problematic polypharmacy within local areas.
Population Health Management
Through a series of national webinars, education and training, the programme supports the routine use of NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients, promoting shared decision-making in structured medication reviews.
See dates for forthcoming webinars and book your place
Clinician training
Training through evidence-based polypharmacy Action Learning Sets (ALS) is being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
Get details of our upcoming ALS cohorts and book your place
Patient Engagement
We are also working with patients and the public to drive regional testing and evaluation of public-facing initiatives to change public perceptions of prescribed prescriptions and encourage patients to be open about their medication concerns and expectations.
Patients have access to a range of patient information materials in 11 different community languages to prepare for their medication review including a patient invitation letter for a SMR, the Me and My Medicines charter, which aims to improve conversations between patients and their clinician, and the ‘Safely stopping medicines’ leaflet to help communicate medication changes after an SMR.
All resources are also available in easy-read and audio format from this link.
To support the use of the patient resources Health Innovation Yorkshire & Humber has worked with local Integrated Care Boards (ICB) teams to produce two SMR videos.
Structure medication review video to support clinicians
This video is for clinicians. It provides an example of a good SMR, with a focus on the shared decision-making process, and supports the education of staff who are less experienced or new to conducting medication reviews in general practice. The video is also helpful to share with other members of the primary care team (e.g. care navigators) to help them understand what SMRs involve.
Structure medication review video to support patients
This video is for patients who take multiple medications and may require an SMR. It shows what to expect and encourages patients to articulate their needs, preferences and circumstances as part of the shared decision-making process.
Recordings of previous masterclasses are available below
A masterclass delivered to GPs, pharmacists, pharmacy technicians and nurses who are involved in reviewing anti-psychotics and potentially de-prescribing. The masterclass covers considerations when reviewing and de-prescribing antipsychotics in people living with dementia and frailty as well as de-prescribing antipsychotics in adults.
Reviewing and de-prescribing antipsychotics in people living with dementia and frailty
In this masterclass mental health pharmacists who have a wealth of knowledge cover practicalities of deprescribing anti-depressants in elderly patients and reviewing inappropriate prescribing. The session focuses on pharmacists and nurses in primary or secondary care who may come across antidepressants that require stopping or tapering and gives practical advice and real-life examples based on clinical evidence and experience.
A masterclass to highlight the practicalities of assessing ACB score and how to withdraw medication effectively and safely. Presenters Heather Smith (Consultant Pharmacist: Older People, West Yorkshire ICB) and Anne Bentley (Lead Pharmacist, Digital Care Hub, Airedale NHS Foundation Trust, and Chair of the Pharmacist Group at the British Geriatric Society) set the scene around the impact of Anticholinergic Burden as well as calculating ACB scores alongside cases studies showing how to work with patients to reduce anticholinergic impacts.
This masterclass includes six sessions:
- Building the Infrastructure of Community Pain Support: in this session, Kerry Page, Programme Manager at Rethinking Pain, discusses how Rethinking Pain aims to transform pain management across the region.
- Pragmatic Approach to De-Prescribing Opioid Based Medication: in this session, Dr. Asim Suleman, Clinical Lead at Rethinking Pain Service, highlights the risks involved with opioid-based medication and considerations to make when prescribing opioid/opiate medication.
- Framework of Opioid Stewardship in Primary Care: in this session, Dr Shahzad Jamil and Dr Yasir Abbasi explore what needs to be done to enable us to move forward in creating a framework for opiate prescribing in Primary Care.
- Identifying Patients and Local Prescribing Data: in this session, Nicola Chicken, Project Manager at Health Innovation Yorkshire & Humber, looks at how we identify patients who are at potential risk of harm from opioid use.
- The Language of Pain: in this session, Mark I.Johnson, Professor of Pain & Analgesia at Leeds Beckett University, outlines the language of Pain and how we engage and communicate with people through their pain journey.
- Developing Good Practice: in this session, Dr. Shahzad Jamil discusses what constitutes good clinical practice in respect to long-term Opioid Prescribing and why we need to give focus to this topic.
The impact of anticholinergic burden (ACB) on older people is well recognised, but how do we embed reviewing ACB into routine practice?
In this masterclass ‘Managing anticholinergic burden: top tips and practicalities’ expert speakers offer practical insights into managing ACB in clinical practice.
Presentations and discussions covered:
• ACB overview – Heather Smith (Consultant Pharmacist for Older People, West Yorkshire ICB)
• New ACB guidance for clinicians and ACB Information leaflet for patients – Sarah Mitchell-Gears (Principal Pharmacist, Older People, Bradford District Care NHS Foundation Trust)
• A pragmatic approach to ACB reviews and top tips – Hadeel Mohamed (Polypharmacy Clinical Lead)
• Practical examples from clinical practice (presenters from primary care, secondary care and care homes)
Managing anticholinergic burden (ACB) – Top tips and practicalities