The PEP Talk this month on polypharmacy challenged us as a group to identify some actions we would take out to the Pinnacle MHN Network of practices to help reduce the burden of medications on our populations.
Thinking about the hundreds of thousands of patients on five or more medications a day, and the impact this may have on them in risk of falls, cognitive impairment, confidence and sheer work involved in managing the medications - what things could make a difference?
We came up with four key activities for practices to consider.
When making a change in medication it really helps the patient if the pharmacist knows why the change was made - they can reinforce the message, and make sure they set up the medication in the right formulation, or the right "pod" in the patient's daily dispensing tool.
We asked the question - how does this work in the signatureless , e-prescribing world?
The GP can write a "comment" to the pharmacist, which appears as a message when the prescription is viewed in the pharmacy - but it may be worth having a chat with your community pharmacist about how this actually looks.
In the olden days we could write a note on the prescription itself - is this method as effective and if not what can you both do about it?
When it is left to just remembering to do the right thing, people do the right thing maybe 10 per cent of the time (depending on what the right thing is!), a visual reminder to think - maybe a poster on the wall - or a prompt or automated system that flags an alert when patients are taking more than five medicines, may be helpful.
Patients who only come in when they are unwell, or with a long list of issues they have saved up, patients who don't care who they see are hard to deprescribe. Identifying patients who could benefit from a "proactive health care plan" may be a start, encouraging those patients to see the same prescriber each time, even if it does mean making an advanced appointment, using telehealth where you can to improve access, may all help.
Actively referring people for a medicines review may be a bit of a faff, but even if it is just a personal connection you have with the community pharmacist and simply asking them for their help with a patient, making sure the patient really understands what the medicines are for, it can be really helpful.
Jo Scott-Jones, Medical director
027 475 0488