Question every medicine

Polypharmacy is a disease in itself and one that can potentially have more serious consequences than the conditions for which multiple drugs have been prescribed, delegates at October's Pharmacy Show heard

Speaking at the show, elderly care pharmacist Graham Stretch urged all community pharmacists to question whether everything on a patient’s prescription was clinically necessary and to challenge prescribers to reduce the burden of medication if they had any doubts.

“This is everybody’s business,” said Dr Stretch, who is chief pharmacist at London’s Argyle Health Group and chair of the Primary Care Pharmacy Association (PCPA) care home group.

Dr Stretch acknowledged that there were several barriers to deprescribing, from the widely-held belief that there was ‘a pill for every ill’, and over-diagnosis of conditions that were unlikely to cause illness, to a failure to review drug therapy and continue items out of habit.

In a separate address at the event, Helen Kilminster, chair of the PCPA’s practice pharmacy group, said that in order for patients to feel that deprescribing can be the right thing to do, education was required to change attitudes regarding what medicines can deliver. Pharmacists also needed to have the confidence to suggest changes, as well as a willingness to work with other healthcare professionals, she added. “We are our own biggest critics but we are good at patient care.”

Elderly will benefit

The group who will gain the most benefit from deprescribing is the elderly, said Dr Stretch, as the ageing population meant that more people than ever were living with several concurrent conditions and so were more likely to be on multiple medicines. This simply is not acceptable, he said. “We are giving all these medicines to the people least likely to cope with them.” He highlighted other issues that polypharmacy brought with it, from medicines wastage to poor adherence, but added that the latter, in many cases, “probably saves them”.

Dr Stretch suggested an approach of picking off the drugs that could cause the most harm, such as anticholinergics or drugs that have this effect. He reminded delegates to bear in mind that circumstances change, giving the example of someone who had been on oxybutynin for incontinence but was now in a care home with round-theclock care. This person might be better served by using a pad rather than medication that brought with it a slew of side-effects – which would lead to further prescribing.

Ask the right questions

Wasim Baqir, national pharmacy lead for care homes at NHS England, said that this was a natural extension of the ‘Making every contact count’ theme, and advised avoiding asking patients “what’s wrong?” but instead trying to explore their requirements through questions such as “Are you happy with your medicines?” and “What is important to you about your treatment?”.

Every drug should have a reason for it having been prescribed, be safe for the individual taking it and meet the patient’s expectations in terms of how it benefits their life, he explained.

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