NHS policies to improve care for people taking multiple medicines may not be effective
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Current NHS policies designed to improve care for people taking multiple medicines may not be effective, according to new research.
In England, more than one in seven people take five or more medicines daily, leading to growing concerns over the overuse of medicines – known as polypharmacy – because of potential side effects and patient harms.
The new study is funded by the National Institute for Health and Care Research (NIHR) and led by the universities of Exeter and Bristol. Published in The Lancet Healthy Longevity, it looked at how medication safety in general practice might be improved for people taking lots of medicines.
Drawing on current NHS policy recommendations, the researchers developed a process involving rigorous reviews of a person’s medicines by a pharmacist and GP, and compared this new method of care with the usual type of care carried out in GP practices.
They found that the enhanced process did not lead to improvements in safe prescribing for patients taking multiple medicines.
The findings suggest the need to reconsider NHS approaches to improving medication safety for people with complex prescriptions, with researchers calling for future policies to be revised to ensure efficient and effective use of resources.
Professor Rupert Payne of the University of Exeter, who led the project, said: “This is one of the largest studies of its kind. It adds strong evidence that the strategies being used by the NHS to improve medicines safety need to be reconsidered. We’ve also learned that there are ways we can improve the experience of patients and help GPs and pharmacists to work more effectively together. The NHS should look at how this might be made to happen in practice, as more of the same doesn’t seem to be working.”
The study involved around 1,700 patients from 37 GP practices across the West Midlands and South West England. The new approach tested in the research involved rigorous medication reviews carried out jointly by GPs and pharmacists. It aimed to build on existing NHS initiatives, promoting closer collaboration between healthcare professionals and supporting their work through a dedicated computer program.
While the study found no improvement in safe prescribing compared with usual care, there was some evidence that it did reduce the effort patients have to make to manage their treatment. Participants also reported high levels of satisfaction with their care, and healthcare professionals valued the opportunity to work more closely together.
Most long-term care for people experiencing polypharmacy occurs in general practice. Current NHS policies to improve medicine safety include expanding the role of clinical pharmacists and recommending regular “structured medication reviews” for certain patient groups. However, there has been limited high-quality evidence to support the effectiveness of these approaches – something this new research sought to address.
Dr Deborah McCahon, Senior Research Fellow at Bristol Medical School at the University of Bristol, added: “Polypharmacy is a huge challenge for the health service, with the NHS spending around £20 billion each year on medicines. Our research suggests the NHS needs to rethink its approach to this issue and provides important insights into how care can be improved to better support patients living with polypharmacy.”
The paper is titled ‘Optimising polypharmacy management in primary care through general practitioner−pharmacist collaboration, informatics, and enhancing clinician engagement: the IMPPP cluster-randomised trial’ and is published in The Lancet Healthy Longevity.
