Policy, medical training and clinical practice have failed to adapt to a significant increase in the number of patients taking multiple prescription drugs, according to a new report published by The King’s Fund and co-authored by Tony Avery, Professor of Primary Health Care in the School of Medicine at The University of Nottingham.(1)(3)
Professor Avery said: “We are finding that increasing numbers of people are taking large amounts of medicines each day. This is not necessarily a bad thing, but sometimes it can result in harm, and sometimes patients cannot cope with the pill burden. Our report highlights the ways in which we can try and tackle the issues around ‘polypharmacy’ so that patients don’t have to take more medicines than they really need.”
Estimates suggest that from 1995 to 2010 the number of patients taking ten or more medicines trebled(2), reflecting a large increase in the number of people with complex, or several, long-term conditions - largely driven by an ageing and increasingly frail population but also by increasing use of multiple interventions. While taking numerous prescription drugs (polypharmacy) has often been seen as something to be avoided in the past, the report shows that taking an evidence-based approach to polypharmacy should improve outcomes for many people.
However, with most research and health systems based on single disease frameworks, policy, medical training and clinical practice have often not adapted to provide ‘appropriate polypharmacy’ - optimising the use of multiple medicines and prescribing them according to best evidence. Our report suggests that for polypharmacy to be used more effectively there needs to be:
The report argues that polypharmacy needs to be better understood and defined, and accompanied by more engagement with patients to ensure that medicines are taken in the way that prescribers intend. This may require compromise between prescribers and patients to ensure that patients feel confident in what they are taking and situations where medicines go unused or are wasted are avoided.
Integrated care is now widely accepted as the way forward in caring for people living with multiple, complex, long-term conditions. Appropriate polypharmacy, or medicines optimisation, now needs to be similarly accepted as one of the ways in which we can deliver more coordinated care.
Martin Duerden, the report’s lead author, said: “Currently patients may still be treated in silos where one specialist doctor will look after their care for diabetes, another for their heart condition and a third for their asthma. They will then be prescribed medicines for each condition but these are often not considered in the whole. We need more generalist doctors able to understand a patient’s medicine in-take in its entirety and how they are managing, especially if they have to take numerous medicines at different times in the day.
“A sensible way forward might be to identify those taking ten or more medicines and focus on them first. Their medicine intake should be regularly reviewed so that as well as adding a medicine as a condition worsens you can also scale back or even stop treatment – particularly recognising that end-of-life quality applies to chronic as well as cancer conditions.”
1. Polypharmacy and medicines optimisation: safe and sound by Martin Duerden, Tony Avery and Rupert Payne is available free to download or to purchase for £5 at: www.kingsfund.org.uk/polypharmacy
2. Between 1995 and 2010 the proportion of people in a study of 300,000 patients in Scotland taking 10 or more drugs increased from 1.9 per cent to 5.8 per cent. This was a study by Guthrie and Makubate (2012).
3. Read coverage of the report by the British Medical Journal.
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More information is available from Professor Tony Avery on +44 (0)115 8230209, firstname.lastname@example.org or Cara Phillips, Senior Press and Public Affairs Officer at the King’s Fund on + 44 (0) 207 3072603, email@example.com or Lindsay Brooke, Media Relations Manager at The University of Nottingham on +44 (0)115 9515751., Media Relations Manager at The University of Nottingham on +44 (0)115 9515751.
Posted on Friday 29th November 2013