With more than 1 billion prescription items dispensed in the UK each year and an ageing population with complex health needs, it has never been more important to work with patients to optimise their use of medicines. Driven by polypharmacy concerns, the side effect burden and the resources required to sustain ever-growing levels of medicine use, deprescribing is becoming an increasingly vital component of pharmacy practice.
In this learning episode of The PJ Pod, we have enlisted the help of two experts to explore what it takes to deliver effective deprescribing and ask what pharmacists can do to help patients get the most from their medicines.
By the end of the episode, you will be able to:
- Understand the importance of shared decision making and patient expertise when discussing a potential change to their use of medicines;
- Appreciate situations where a deprescribing decision could benefit the patient;
- Understand the role of evidence and how to use it as a starting point for conversations with patients;
- Recognise some of the common barriers to deprescribing and the role of the multidisciplinary team.
Many thanks to Lelly Oboh, consultant pharmacist, care of older people at Guys and St Thomas’ NHS Community Health Services, and Tony Avery, GP and professor of primary health care at the University of Nottingham and NHS England’s national clinical director for prescribing, for their expertise.
This programme is presented by Alex Clabburn, senior editor, research and learning, and was produced by Geoff Marsh.
Further resources
Articles on deprescribing and clinical appropriateness in The Pharmaceutical Journal
- Polypharmacy: a framework for theory and practice;
- Polypharmacy: putting the framework into practice;
- How to evaluate the clinical appropriateness of an antimicrobial;
- Critical appraisal: how to evaluate research for use in clinical practice;
- How to use clinical reasoning in pharmacy.
Articles on consultation skills in The Pharmaceutical Journal
- How to provide patients with the right information to make informed decisions;
- Approaching difficult situations: how to have challenging conversations.
Research
For more research on deprescribing, look out for the forthcoming special issue of the International Journal of Pharmacy Practice in April 2023.
Other resources
AHSN Polypharmacy Action Learning Sets: information about evidence-based training available as part of the AHSN Polypharmacy Programme
GP Evidence: a resource developed for GPs designed to make the scientific evidence underpinning guideline-recommended treatments easier to access and understand
Me and My Medicines: a campaign led by patients and supported by clinical staff to help people raise concerns and use their medicines better
‘Polypharmacy guidance: realistic prescribing, 3rd edition‘: Published by NHS Scotland providing guidance on preventing inappropriate polypharmacy at every stage of the patient journey including the ‘7 steps to appropriate polypharmacy’
‘Good for you, good for us, good for everybody: a plan to reduce overprescribing to make patient care better and safer, support the NHS and reduce carbon emissions‘: the findings and recommendations of the national overprescribing review
‘Understanding polypharmacy, overprescribing and deprescribing‘: A collection of practical information produced by the NHS Specialist Pharmacy Services, including:
- Tools to support medication review;
- Taking a person-centred approach to managing polypharmacy.
‘Polypharmacy: guidance for prescribing‘: produced by NHS Wales containing support and additional information to help with prioritisation of medication.
Journal articles
Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, et al. ‘Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis.’ Health Technol Assess 2022;26(32). doi: 10.3310/AAFO2475
Barnett, N & Kelly, O. ‘Deprescribing: is the law on your side?’ Eur J Hosp Pharm 2017 Jan;24(1):21-25. doi: 10.1136/ejhpharm-2016-000949
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