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

2. 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 (
2. Department of Health, Long Term Conditions Compendium of Information, 2012 (
3. HSCIC, Prescriptions dispensed in the community, England , July 2014 (

3. 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 , July 2014 (
4. NHS Choices, Prescriptions '1 in 20 has an error', 2012 (
5. University of Nottingham, Prescribing Safety and Overview of PINCER, September 2014 (

4. 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 (

5. 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 (

6. 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 (
3. HSCIC, Prescriptions dispensed in the community, England , July 2014 (
10. The King's Fund, Polypharmacy and medicines optimisation, making it safe and sound, 2013 (

7. NICE
Reference
10. NICE, Medicines optimisation overview pathways, 2015 (

8. % of Pharmacies conducting MUR
Reference
17. NHS England, Medicines Optimisation Dashboard, June Community Support, % of pharmacies conducting MUR (

9. 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

10. Patient video

11. 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?