What was the issue you were addressing or working on?
The aim was to support clinicians in making person centred decisions, to assess and balance the risks associated with Polypharmacy in the elderly. This evidenced improvements in terms of reduced numbers of repeat medications, high levels of staff and patient satisfaction and increased efficiency within the prescribing budgets.
What you did?
Polypharmacy refers to the concurrent use of multiple medications by a single patient. Use of multiple medications predisposes older people to adverse drug reactions. We have developed, tested and are rolling out a multi-disciplinary model within general practice of Polypharmacy review of patients aged 75 or over on 12 or more repeat medications.
The model for the clinic involved:
- identify people over the age of 75 on 12 or more repeat medications within an agreed cohort of general practices. Patient and /or carer contacted by a senior administrator to explain the purpose of the review and agree an appointment time. The phone call was followed up by a written appointment letter.
- Patient’s acute medical records were reviewed.
- 20 – 30 minute review of patient (accompanied by carer where possible) by 3 clinicians focussing on medication compliance, understanding of medication and clinical review of prescribed medication.
- Joint agreement with patient/carer about proposed changes
- Letter sent to patient confirming medication changes and copied into general practice and secondary care records.
- One month post clinic review of patients
What were the outcomes - benefits or otherwise?
658 patients have been reviewed (to September 2013). The average number of medications pre-test was 13 and the average number of medications post test was 11.5 per patient. There has been very positive feedback from patients who have participated in a polypharmacy review with the majority understanding medications better and over 30% reporting they feel better as result of changes made to their medication.