A quality improvement approach to addressing problematic polypharmacy

Joanna Garrett, Senior Project Manager here at the West of England AHSN, reflects on our work bringing together pharmacists, GPs, commissioners and patients to tackle problematic polypharmacy.

Medicines are the most common intervention used by the NHS, but up to 50% of medicines are not taken as prescribed. Barriers to adherence are complex and varied but ultimately, in many cases, clinicians and their patients are not working together as effectively as they could be to reach the best possible outcome of care.

So how do we fix this? Evidence tells us that helping patients to be actively involved in their own care, treatment and support can improve their outcomes and experience. However, as healthcare professionals we must ensure that patients have the skills and knowledge to manage their own health.

With this in mind, in December 2018 we held the first in our series of polypharmacy events to bring pharmacists, GPs, commissioners and patients together to begin thinking about this complex topic.

At this launch event, we asked attendees to make pledges about the actions they would be taking in their own organisations. One of the pledges the West of England AHSN made was to develop a Medicines Safety dashboard which would pull in data from ePACT2, an online prescription database.

Taking a quality improvement approach, we developed the dashboard in the West of England over the last six months in conjunction with the Patient Safety Measurement Unit, and then presented it to delegates at our second polypharmacy event on 12 June 2019.

Again, experts and patients from across the region came together to discuss polypharmacy, learn the principles of quality improvement and test the ePACT2 dashboard. Whilst most people in the room were aware of the ePACT2 prescription data, the number of people who have previously accessed this dataset was limited. The dashboard provides and simple and easy-to-use way of reviewing some specifically chosen metrics by practice, CCG and STP. This will really help pharmacists, GPs and commissioners to work out where the problems are in polypharmacy and work with patients to make improvements.

The dashboard is still in development and we’re grateful for the feedback you have provided already. Please get in touch if you have any more suggestions or comments.

Working together holistically

In the majority of circumstances patients themselves ultimately are responsible for when and how they take their medicines, or whether they even take them at all. They therefore have a key role achieving the intended outcome from using medicines. Me + my medicines is one simple project discussed at the event that is being explored nationally. The campaign and the charter is not about a specific clinical area or a specific medicine, but it’s about encouraging honesty and mutual respect to ensure we have a better conversation about medicines. Take a look at their website for more information.

Fiona Castle, Chief Officer at Swindon and Wiltshire LPC, concluded the day with an interesting discussion about the important role of community pharmacists, particularly in the evolving healthcare world that we are currently working in. Community pharmacists have frequent contact with patients and carers and can facilitate conversations in a less formal environment which may be of benefit for some patients.

In the words of Phillipe Pinel in the 1800’s ‘it is an art of no little importance to administer medicines properly; but, it is an art of much greater and more difficult acquisition to know when to suspend or altogether omit them’.

Clearly the issues of polypharmacy and deprescribing are not new, but as Fiona Castle summarised, we must work together holistically, across a system, and with patients to reach the best possible outcome of care for every patient.

The West of England AHSN Lead Pharmacist Mark Gregory recently wrote a blog about the risks vs benefits of polypharmacy. Read Mark’s blog here.

Posted on June 14, 2019 by Joanna Garrett, Senior Project Manager, West of England AHSN

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