Talking about polypharmacy: the service user perspective

As the population ages and polypharmacy grows, the challenge of optimising patient medication becomes increasingly complex. The ‘National overprescribing review’, published in September 2021, recognised the need to change the culture of prescribing in the NHS and the importance of engaging service users in this complex task​[1]​. The review highlighted the need for further research to identify behavioural change messages, and interventions that are effective in reducing overprescribing and that empower service users to be more involved in decisions about their care. 

Although several campaigns have been developed, both in the UK and abroad, to encourage more open conversations about medicines between service users and clinicians, evidence is lacking as to whether these initiatives are effective. To address this knowledge gap, the national Academic Health Science Network’s (AHSN’s) polypharmacy programme ‘Getting the balance right’, was launched in April 2022​[2]​. Part of this programme involves evaluating campaigns that aim to support better conversations about medicines. 

Between April and August 2022, UCLPartners asked people at higher risk of experiencing problematic polypharmacy (i.e. those taking five or more regular medications), together with their carers and clinicians, for feedback to inform this work.  

In an initial focus group discussion, 12 service users and their carers — recruited through the UCLPartners Patient and Public Involvement and Engagement Network — were introduced to three pre-existing behaviour change campaigns: the World Health Organization’s (WHO’s) ‘5 Moments for Medication Safety’, ‘Me + My Medicines’, and the AHSN’s ‘Are your medicines working for you?’​[3–5]​. After much discussion, participants chose ‘5 Moments for Medication Safety’ as their preferred campaign. Developed as part of the third WHO Global Patient Safety Challenge: ‘Medication Without Harm’, the campaign aims to encourage service users to ask questions about the medications they are taking, especially at key moments, such as when starting a new medication or stopping an old one​[6]​.  

A second follow-up focus group discussion was held with ten of the original focus group participants,  which enabled further discussion of how the campaign might be used in practice, particularly in the context of structured medication reviews.  

To incorporate the views of a wider range of service users and carers, an online survey about the campaign was created and shared through UCLPartners’ networks and local voluntary sector organisations, including several branches of Age UK and Healthwatch. A total of 28 service users and carers took part in the survey over six weeks, between June and August 2022. Informed by focus group findings, survey respondents were asked for their views on how the campaign should be implemented and evaluated, for example: “In what other settings would you like these campaign resources to be used?” and “What other benefits would you expect patients to experience if the campaign is successful?”. 

In July 2022, an additional focus group discussion was held with clinicians to capture their perspective on the local implementation and evaluation of the campaign. A total of 11 multidisciplinary clinicians participated, representing both primary and secondary care, including physical and mental health services.   

In total, more than 50 service users, carers and clinicians took part in this engagement work, making invaluable suggestions about how this campaign should be used in practice. UCLPartners have used this feedback to shape the local roll out and testing of this campaign, which began in 2022 and should finish in March 2023. This work is assisting the national AHSN polypharmacy programme, and its findings will contribute to the wider evidence base concerning such interventions.  

This work has highlighted many barriers to having open conversations about medicines, including time constraints and lack of trust, as well as the significant impact that this can have on all those involved — no one benefits when things are left unsaid during consultations. Without open conversations about medicines, both service users and clinicians lose out on important information which could affect the decisions they make. 

For progress to be made, it is imperative that service users and clinicians work together to improve the prescribing culture in the NHS — and in other systems worldwide — to maximise the benefits patients receive from their medications. Through better partnership working, we hope advances can be made on this multifaceted issue.  

For more information on this engagement work, the full report can be accessed here. 

Victoria Kirkby is a public health medicine specialty registrar based in central London. This work was undertaken as part of the Darzi Fellowship, in association with University College London Hospitals NHS Foundation Trust.