Polypharmacy is often incorrectly summarised as patients taking “too many medicines”, but the reality is much more complicated than that. The concern should be less about the number of medicines taken and more about their appropriateness — i.e. is this medicine what the patient needs, wants and is able to take?
Even though the number of medicines that patients are taking is increasing, it does not always follow that this is a bad thing. Yes, there is a higher risk of adverse drug reactions and interactions, but appropriate polypharmacy can extend life expectancy and improve quality of life. It is important that the rational use of medicines is tailored to the individual patient. It is these principles that are at the centre of an initiative by The Pharmaceutical Journal to collate evidence of best practice in this area, often neglected by clinical trials and guidelines.
We published a call for papers in October 2018 and we will be publishing the submissions we received in November and December 2019. This month we have published a CPD article from Fiona Allan et al. from NHS Fife and the University of Edinburgh, distilling the main principles that should be considered implementing a medicines optimisation programme into one easy-to-follow framework.
If implemented at scale, pharmacist-led programmes can have a real impact on the health economy of the local area
This approach will be crucial as pharmacists in primary care networks in England, and other GP-based pharmacists in Scotland and Wales, begin to carry out structured medication reviews and seek to rationalise medicines use in their local areas. In December 2019, we will publish a case study to accompany and help explain this framework, following one patient through her polypharmacy journey.
If implemented at scale, pharmacist-led programmes like this can have a real impact on the health economy of the local area. We have published research by Robert Brownsmith, medicines optimisation pharmacist with NHS Portsmouth Clinical Commissioning Group (CCG), which highlights the impact of pharmacist consultations and assistive technologies in ensuring medicines safety and delivering potential cost savings to the NHS of £250,290 in 2017 and £170,100 in 2018, through reduced hospital admissions.
Then, in December 2019, we will publish further research that highlights the work of pharmacists based in the NHS East Staffordshire CCG medicines optimisation team, who developed and implemented polypharmacy clinics within GP surgeries, reduced hospital admissions and generated more than £50,000 in cost savings.
Pharmacists will have to develop sophisticated clinical skills in order to effectively — and sensitively — manage patients’ medicines and ensure the best care necessary across primary and secondary care. These skills are demonstrated well by Ana Armstrong, lead specialist clinical pharmacist for community medical teams and frail older people at NHS Surrey Downs CCG, who outlines a typical day supporting older patients at home.
By working closely with patients and other healthcare professionals, these examples prove the extensive impact that pharmacists can make in medicines optimisation. The secret is to ensure that all patients with complex needs have access to such great pharmacist-led care.