Medicines Optimisation Polypharmacy and Deprescribing Clare Howard FFRPS FRPharmS Clinical Lead Medicines Optimisation Vicki Rowse Programme Manager Medicines Optimisation

Why is this an issue? Getting the most from medicines for both patients and the NHS is becoming increasingly important. It is estimated that: Between 30 and 50% of medicines prescribed for LTCs are not taken as intended1 15 million people in England now have a LTC2 14% of people under 40 and 58% of people aged 60 and over have at least one LTC2 2.9 million people will have multi-morbidity by 20182 25% of people over 60 report having two or more LTCs2 Between 2003 and 2013 the average number of prescription items per year for any one person increased from 13 to 193 References: NICE, Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes, March 2015 (http://www.nice.org.uk/guidance/ng5/resources/medicines-optimisation-the-safe-and-effective-use-of-medicines-to-enable-the-best-possible-outcomes-51041805253) 2. Department of Health, Long Term Conditions Compendium of Information, 2012 (https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition) 3. HSCIC, Prescriptions dispensed in the community, England 2003-13, July 2014 (http://www.hscic.gov.uk/catalogue/PUB14414/pres-disp-com-eng-2003-13-rep.pdf)

Medication Safety But we aren’t getting it right… Evidence from primary care shows 1 in 20 prescription items has an error and 1 in 550 is serious4 In 2013 there were over 1 billion items dispensed in England therefore this equates to 1.8 million serious errors3 Accounts for 1 in 25 hospital admissions5 Over 50% were in 4 disease classes, antiplatelets, NSAIDs, diuretics and anticoagulants5 References: 3. HSCIC, Prescriptions dispensed in the community, England 2003-13, July 2014 (http://www.hscic.gov.uk/catalogue/PUB14414/pres-disp-com-eng-2003-13-rep.pdf) 4. NHS Choices, Prescriptions '1 in 20 has an error', 2012 (http://www.nhs.uk/news/2012/05may/Pages/gmc-medication-prescribing-errors-report.aspx) 5. University of Nottingham, Prescribing Safety and Overview of PINCER, September 2014 (https://www.nottingham.ac.uk/primis/documents/pptsforum2014/prescribingsafetypincertonyaverysarahrodgers.pdf

Medication Safety Secondary care not better. EQUIP Study showed:6 Error rate of 7% of medication orders 52 errors per 100 admissions 24 errors per 1,000 patient days References: 6. EQUIP, FINAL report prevalence and causes of prescribing errors (http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf)

Polypharmacy Kings Fund Poly Pharmacy and Medicines Optimisation NICE MO short clinical guideline published 2015 References: 6. EQUIP, FINAL report prevalence and causes of prescribing errors (http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf)

What messages do they have? Medicines Optimisation is defined as “a person-centered approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines”1. NICE GUIDANCE (NG5) Between 2003 and 2013 the average number of prescriptions for any one person per year in England rose from 13 to 193 Better use of data Patient centered care (including shared decision making) Transfer of care Medication safety KING’S FUND In problematic polypharmacy, there can be increased risk of drug interactions and ADRs, impaired adherence and QoL for patients10 References: NICE, Medicines Optimisation: the safe and effective use of medicines to enable the best possible outcomes, March 2015 (http://www.nice.org.uk/guidance/ng5/resources/medicines-optimisation-the-safe-and-effective-use-of-medicines-to-enable-the-best-possible-outcomes-51041805253) 3. HSCIC, Prescriptions dispensed in the community, England 2003-13, July 2014 (http://www.hscic.gov.uk/catalogue/PUB14414/pres-disp-com-eng-2003-13-rep.pdf) 10. The King's Fund, Polypharmacy and medicines optimisation, making it safe and sound, 2013 (http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf

NICE Reference 10. NICE, Medicines optimisation overview pathways, 2015 (http://pathways.nice.org.uk/pathways/medicines-optimisation)

% of Pharmacies conducting MUR Reference 17. NHS England, Medicines Optimisation Dashboard, June 2014 - Community Support, % of pharmacies conducting MUR (http://www.england.nhs.uk/ourwork/pe/mo-dash/#mo-dash)

Workshop We don’t have the answers! You’ll hear from people working on this We can agree where our efforts should focus AHSN role in supporting spread

Patient video http://www.leedswestccg.nhs.uk/news/leeds-care-home-patients-benefit-medication-review-service/ https://youtu.be/mjTFP7bIZ2o

Workshop 1. How has QOF affected polypharmacy and how are you addressing this? 2. What is the role of the community pharmacy? 3. How has your organisation addressed polypharmacy? 4. How can we address polypharmacy when patients move between care settings?