Inappropriate prescribing and polypharmacy in patients is associated with increased risk of falls, adverse drug events, hospital admissions and death.
A person taking 10 or more medicines is 300% more likely to be admitted to hospital and 6.5% of hospital admissions are for adverse effects of medicines, this rises to 17% in the over 65 age group and over 70% of these admissions could be avoided. (1,2).
The population in West Kent CCG is expected to increase from 471,791 residents in 2014to 561,883 residents in 2035, an increase of 19.1%. The largest increase is expected in the over 65 age band, a 59.4% increase, accounting for an additional 52,647 people. The percentage increase in population aged over 85 between 2015 and 2020 is 22.4%, equating to an additional 2,848 individuals.
Avoiding hospital admissions and shifting care from acute to community settings will improve the patient experiences, whilst reducing pressures on acute providers.
The aim of the project was to reduce the risks of problematic polypharmacy by targeting those most at risk i.e. over 65 years and prescribed 8+ medicines.
References
The project was included within NHS West Kent CCG's prescribing incentive scheme for 2016-17 and 2017-18. Practices were required to conduct medication reviews on a proportion of the highlighted patients that equates to 1% of the practice population, with a view to deprescribe in suitable patients.
We developed a deprescribing resource guide to help practices effectively review patients. Patients were identified by a search on the GP clinical system for patients aged 60 years+ and prescribed 8 or more medicines. The practices were required to conduct face-to-face or telephone reviews with a proportion of the identified patients that equates to a minimum of 1% of the Practice population.
Practices also had to complete a summary template sheet, which was a one page document which easily allowed GPs to record the date, the medication stopped and the reasons for stopping the medicine. By using simple template sheets such as this, GPs didn't feel burdended by paperwork and once submitted allowed the medicines optimization team to quickly and easily validate the project.
Patients are the main beneficiaries of the project. GPs were asked to review patients and stop medication that was no longer required or step down doses when suitable. This helps to reduce the pill burden in a high risk group of patients and also reduce the risk of suffering side effects from medicines.
10,175 summary template forms received from 54 GP practices with an estimated cost saving of £600,000.
Examples of interventions:
