Around 40% of people over 65 are on five or more medications today. Of these, between 10% and 30% experience adverse drug reactions, and nearly half are non-adherent. It is thought that the cost of adverse drug reactions alone could exceed £2.2 billion per year, while £300 million is wasted annually on unused medicines.* Thousands of preventable hospital admissions also happen every year due to complications related to medicines.
These numbers are likely to rise further as our population ages over the next few decades – so how do we start to manage this rising tide of polypharmacy and prevent more cases of harmful overprescribing in the years ahead?
Five key challenges
Optum recently facilitated a workshop at the HSJ’s ICS Medicines Forum, bringing together healthcare professionals from across England to explore the challenges and potential solutions.
What became clear is that polypharmacy is a complex, multi-faceted issue – and that there are no quick fixes. However, our discussions did arrive at five strategic challenges that need to be addressed.
These are discussed fully in our new white paper Connecting the dots: Action on polypharmacy and overprescribing – this blog provides a brief overview of each challenge.
1. The technology challenge – delivering a more connected picture for practitioners
First, we heard that one of the biggest challenges that practitioners face is accessing comprehensive, up-to-date patient information. When there is poor join-up between different healthcare record systems, it can be difficult for pharmacists and other primary care and community-based teams to get a full picture of a patient’s medication history, particularly when patients are treated across multiple settings.
Delegates therefore called for a new generation of digital solutions that enable better integration of patient information across different care settings. This would give pharmacists a more joined up and connected picture of the patient’s clinical history, making it easier to assess whether changes to a patient’s medication are necessary. Mobile technologies for community-based teams were also felt to be essential for putting this information into the hands of those working remotely.
2. The data challenge – setting the parameters for success across the system
Linked to this, many respondents also highlighted difficulties getting hold of reliable and meaningful data to shape decision-making. This was sometimes due to incomplete or inaccurate reporting, or technical challenges involved in navigating IT systems to drop down the right data. In some cases, practitioners also resorted to collecting their own data manually via spreadsheets – a ‘make-do-and-mend’ approach because they couldn’t access the right tools to help them.
At the other end of the spectrum, there was also concern about data overload, with too many competing dashboards and datasets. This led to an important discussion about how we develop a meaningful and consistent way of describing what success looks like and how we measure it. As well as improving data systems and tools, the conclusion therefore was that we need more consistent ways of measuring impact, specifically by agreeing common metrics to assess whether interventions are delivering against a given strategy.
3. The people challenge – putting patients at the heart of the process
Deprescribing is a deeply human process involving sensitive, nuanced judgement calls to balance the risks and benefits of changing a person’s medication. Practitioners need to understand the reasons behind a patient’s medication use, their health goals, and their preferences so that they can arrive at a solution that’s best for each individual.
In our discussions, we heard some inspiring examples of good practice – one that sticks out was the role of outreach professionals going into people’s homes to address medication issues in a way that reflected not just clinical considerations but the wider social and environmental factors shaping their health. However, it’s also clear that cultivating these deeper, human interactions to achieve personalised care becomes increasingly difficult when resources are strained.
Respondents described breakdowns in communication between healthcare professionals, particularly at point of transfer, resulting in conflicting advice or missed opportunity to deprescribe. They emphasised too that the process of deprescribing itself can also take time and energy to fulfil – and so, just as there is the New Medicines service to support patients on new medications, some questioned whether a Deprescribing Medicines service may be needed too.
4. The pathways challenge – ensuring continuity of care
A related challenge was the need for better continuity of care, particularly during transitions such as hospital discharge or in cases where patients straddle multiple care pathways. Delegates discussed the importance of having multidisciplinary teams (MDTs) and case management models to ensure better coordination.
Regular structured medication reviews (SMRs) were deemed critical for ensuring that medication is optimised as patients move through the system, while stronger communication between healthcare professionals and close monitoring during transitions were needed to help patients get the joined-up care they need.
To achieve this, delegates felt that funding and contractual models needed to be better aligned with the goal of reducing overprescribing and improving medication safety, so that organisations are incentivised to support patients throughout their care journey.
5. The training challenge – enhancing deprescribing skills and capabilities
Finally, some professionals felt underprepared to manage polypharmacy and overprescribing challenges effectively. As one delegate put it during the conference: “Pharmacists are taught how to prescribe, but not how to deprescribe.”
Respondents highlighted the need for more robust training that focused not just on the clinical aspects of deprescribing, but on strengthening the interpersonal skills necessary to support shared decision-making with patients. Practitioners, in short, needed the right knowledge and capability to determine when deprescribing is appropriate, understand its impact, and identify and engage patients using population health management principles.
How Optum can help
At Optum, we understand that technology alone won’t solve all the challenges facing pharmacy and medicines management teams today. However, we believe that digital solutions can play a critical role in helping manage workload pressures and overcome some of the barriers preventing action on overprescribing.
Our Population360® product is designed to integrate with GP clinical records, helping pharmacy teams to rapidly stratify the patient population according to risk and identify patients who may benefit from proactive interventions. By streamlining these processes, Population360® allows pharmacy professionals to focus on helping patients get the most appropriate and effective medicines for their needs.
To find out more about how Population360® can support your organisation, contact us at [email protected]
You can also download our full white paper, Connecting the dots: action on polypharmacy and overprescribing.
This article was prepared by Sima Jassal and Meera Parkash in a personal capacity. The views, thoughts and opinions expressed by the author of this piece belong to the author and do not purport to represent the views, thoughts and opinions of Optum.
*Source: Evaluation_of_NHS_Medicines_Waste, ©YHEC/School of Pharmacy, University of London
