‘Show me your meds, please’: the impact of home-based medicines assessments

As a complex care GP, based in South Somerset, my role is to perform holistic assessments of patients’ needs within their own homes. This includes people who have recently been discharged from hospital; had frequent admissions to hospital; and/or are involved with multiple health and social care services.

Carrying out these assessments between September 2021 and November 2021, my team and I identified many patients who were non-adherent, leading to significant quantities of medicines being wasted. This only became apparent to us after we had asked to see the patients’ medication and would not have been identified otherwise.

Seeing a patient’s medication is not part of the normal medication review; however, by performing this simple task, we realised we could identify a cohort of the population at increased risk of adverse events from erratic medicines use, poor long-term condition management and, potentially, an undiagnosed condition, such as dementia.

There have been cases where we have discovered large bags of untaken medicines in a patient’s home, including significant quantities of medicines stored in cupboards. Often this would be the first indication that the person was not benefiting from their medicines. 

In turn, this approach can also help to reduce medicines waste and save resources for the NHS. Currently, medicines account for 25% of CO₂ emissions within the NHS in England each year and £300m is wasted on medicines that are thrown away or stockpiled.

As a solution, community staff started to ask to view people’s medicines on routine visits, looking for obvious excess. We paraphrased this as: ‘Show me your meds, please.’

After viewing a patient’s medicines, community staff can report any concerns about medicines not being taken properly. This can be done by any individual community team member, including the complex care team, health coaches, district nurses, community physiotherapists and adult social care.

This information feeds back to primary care teams and the patients discussed in multidisciplinary ‘huddles’ to decide which staff member is the most appropriate to follow them up.

This follow-up ranges from a phone call to a comprehensive, in-person assessment aligned to the patient’s goals. The primary care network (PCN) pharmacist, pharmacy technician, complex care team — including GP, nurse and support worker — and primary care team can all play an important role.

One of the main challenges of this work has been around developing our awareness of the psychological impact of removing or stopping a patient’s medication — there is a risk a patient may feel their medical care is being withdrawn altogether. To overcome this, we ensure that decisions are made with the patient and that we always have a person-centred approach to their care.

There is also the potential challenge of increased clinical workload, which was addressed for us by the enthusiastic involvement of our PCN pharmacist and pharmacy technician, who have been invaluable in helping with assessments and liaising with community pharmacists around communication and changes to medication regimes.

There are two potential methods to address the extra workload required to carry out this impactful intervention: 

1. Fund any extra pharmacy support required through financial savings; initial impact assessment has suggested savings would significantly exceed the costs;
2. Reallocate time for our clinical pharmacy team from an emphasis on routine, high volume — but low impact — medication reviews, to holistic high impact reviews.

In the first three-month pilot, we identified 40 patients who were not adhering to their prescribed medication regime; this accounted for 1 in every 4 people we assessed.

Overall, we identified 1,049 individual months of unused prescription items and the total amount of wasted medication was valued at £10,866. It is estimated that every pound spent on pharmaceuticals generates greenhouse gas emissions of 0.1558kg CO₂; therefore, these wasted medicines represents 1,693kg of avoidable CO₂ emissions — the equivalent of a return flight from London to New York City.

During the pilot, we managed to stop 39 medicines, providing a predicted cost saving over the next 12 months of £3,529 and 549kg CO₂ emissions prevented. 

In more than 50% of cases, medication regimes were simplified. For example, by reducing a patient’s medication from three times a day to twice a day, or if the person needed care to prompt the medication, structuring their regime around care visits. 

Social prescribing, such as attending lunch clubs, befrienders, or signposting to activities, was initiated in 30% of cases. A previously undiagnosed cognitive impairment, which could potentially lead to a dementia diagnosis, was identified in 35% of cases.

Overall, these findings show that it is necessary and important to physically view a patient’s medication at home to help identify non-adherence and potential medicines wastage. 

Our screening question, “show me your meds”, can be asked easily on routine visits by community staff and could be extended to carers and relatives.

It is also important for us all to recognise that poor adherence to medication is an indicator to screen for dementia. 

The medication review should not be considered an isolated intervention, but rather a piece of the jigsaw of a holistic patient assessment. This simple screening question can save resources for the NHS, has a positive impact for the environment and can reduce the risk of patient harm. 

The success of the project has come from good communication with community teams who share the same ethos around person centred care, and although a small descriptive study, this approach could have an enormous impact on patients and the environment if it were scaled up.

Deborah Gompertz is a complex care GP and the clinical lead for complex care in South Somerset