Creating shared learning spaces to help clinicians address problematic polypharmacy

Photo shows pharmacist selecting medicines from shelf

Chris Learoyd is Senior Project Manager at the West of England AHSN, overseeing our medicines optimisation programmes. In this blog, Chris explores some of the work we are currently involved in to help reduce harm from medicines.

Medicines safety and improvement work is complex: patients are prescribed medicines in different settings across the entire healthcare system, by different healthcare professionals.

Naturally, this can create challenges with continuity of care and ensuring treatment remains effective, all whilst reducing harmful side effects. Due to advances in medical care, people are living longer with long-term conditions. This can result in people taking multiple medicines regularly for many years. Taking multiple medicines is also known as polypharmacy.

Taking multiple medicines can help support patients with multiple conditions. However, when these are not regularly reviewed, with unnecessary medicines removed, it can lead to adverse drug reactions.

In England in February 2022, there were 876,317 people on 10 or more medicines and 349,653 of these were 75 or over. A person taking 10 or more medicines is 300% more likely to be admitted to hospital. 

Improving the continuity of care and reducing harm through more preventative approaches to healthcare is a core aim of the NHS Long Term Plan. There have been a number of medicine-related initiatives and services implemented in recent years to provide added ‘safety nets’ and improve system collaboration, including the Discharge Medicines Service, New Medicine Service, and incentives and guidance for Structured Medication Reviews (SMR).

These initiatives and services go some way to reducing the harm from medicines, but clinicians working with patients still face individual challenges addressing inappropriate polypharmacy, with clinicians often feeling isolated in their practice. This is where the national AHSN Network Polypharmacy programme and the West of England Polypharmacy Community of Practice aim to fill the gap.

Our Community of Practice (CoP) offers a safe space for clinicians to share their polypharmacy experiences, successes, and what they have learned from practice. It also highlights areas of common challenge: it’s inspiring to hear how a creative approach to problem-solving shared in a CoP can have a positive impact elsewhere.

The third CoP session held in February 2023 focused on ‘anti-cholinergic burden’. The discussions were fascinating, and they created a buzz amongst the attendees. I have been really inspired by the commitment and enthusiasm of the attendees and it’s been fantastic to see the CoP grow into a genuine space for learning.

A common challenge faced by CoP members is how to engage patients in meaningful and supportive conversations about reducing inappropriate polypharmacy.

Patient engagement in deprescribing is key to shared decision-making that supports the use of alternative treatment approaches and reduces over-reliance on medicines. This topic will be discussed in the next COP session on 15 June: if you’re interested, please do book your space and join us.

It’s recognised it will take time for patients and clinicians to fully adopt effective shared decision-making. To support clinicians gain confidence in carrying out structured medication reviews using shared decision-making processes, the AHSN Network has been delivering evidence-based Polypharmacy Action Learning Sets (known as ALS). Held over three morning sessions, these will continue regularly throughout 2023/24.

Aligning with this work, the West of England AHSN has been testing patient resources to support more open conversations about medicines. This cultural and behavioural change for patients and healthcare is fundamental in addressing polypharmacy, as recommended by the National Overprescribing Review Report, led by Dr Keith Ridge in September 2021.

Initial feedback from local testing has found it helped patients think about their medicines and what they needed to discuss during their medication review. This prompted a more meaningful conversation and increased patient confidence in discussing their medicines. Further testing is proposed for 2023/24, so watch this space for the findings.

Polypharmacy and the potential harm it can cause may not be new; however, working together is fundamental to address it.

To register an interest in the Polypharmacy Action Learning Set training or to discuss joining the region’s community of practice, please contact me at christopher.learoyd@nhs.net.


Posted on April 3, 2023 by Chris Learoyd, Senior Project Manager, West of England AHSN

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