A medicine review is about stopping medicine as much as it is about prescribing

By Dr Mahendra Patel, English Pharmacy Board Member

The RPS has published a joint report with RCGP on polypharmacy “The challenge of polypharmacy: from rhetoric to reality”. The report is a practical guide for the delivery of improved care and increased safety of our patients.

Multimorbidity is perceived as an inevitable consequence of an ageing population, with increasing ‘polypharmacy’ necessary to prevent complications arising from long term conditions.  Patient conditions are often treated individually and they are prescribed medicines accordingly. However, medicines that were once prescribed may no longer be necessary as well as in some instances new medicines may not be required. Pharmacists have a key role in supporting patients to get the most out of their medicines and ensure that they are only taking the medicines that they actually need.

The recommendations of the report, born from extensive discussions between pharmacists and GPs, are primarily focused around:
• Increased involvement of patients in making decisions about their medicines
• Recognition that medicine reviews are fundamental
• Increased inter-professional discussions about managing polypharmacy
• Improved relationship between doctors, pharmacists and patients
• Better utilisation of community pharmacists
• Improved collaboration with pharmacists throughout the NHS, for example in secondary care.

The RPS have worked tirelessly to ensure that pharmacists are integrated into general practice, where many of these patients with multimorbidities present. Many practice pharmacists are undertaking consultations with patients who are on a large number of medicines ensuring that they are appropriate and beneficial.

An in depth medicine review is particularly beneficial for those patients living in care homes, who are often on 7 or more medicines. This, again, is an area where the RPS are working closely with NHS England and other key stakeholders to highlight and support the role of pharmacists working in care homes. Pharmacists can work with patients in these settings to better understand their needs and worries and provide an overview of all their medicines. This type of service would also be beneficial to vulnerable people living in their own homes.

In order to help identify patients who are taking multiple medicines some polypharmacy comparators are being developed. The work on these metrics has been led by Wessex AHSN and they are expected to be made available via ePACT release 2 in the summer.
We must however recognise that as pharmacists we cannot tackle the issue of polypharmacy alone. As more people live longer and potentially have a number of long term conditions, all healthcare professionals need to work together to address the issues of polypharmacy. Later this year, the RPS will be developing guidance on polypharmacy.
Finally, I feel it is imperative we continue to highlight the importance of a good and meaningful relationship between doctors, pharmacists and patients if we are to truly deliver a seamless and effective healthcare service across sectors, ultimately to help improve patient care.


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