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Improve management of patients taking multiple drugs, doctors told

Between 1995 and 2010, the number of patients taking 10 or more drugs trebled

Caroline White

Wednesday, 04 December 2013

Doctors need to improve the management of patents taking several drugs, says a new report from health think tank The King’s Fund.

Policy, medical training, and clinical practice have failed to adapt to a significant increase in the number of patients taking several prescription drugs, it says.

Estimates suggest that from 1995 to 2010 the number of patients taking 10 or more drugs has trebled, reflecting a large increase in the number of people with complex, or multiple long-term conditions.

This has largely been driven by an ageing and increasingly frail population, but also by increasing use of multiple interventions, says the report. Polypharmacy used to been seen as something to be avoided, but taking an evidence-based approach to it should improve outcomes for many people, says the report.

But with most research and health systems based on single-disease frameworks, policy, medical training and clinical practice have often not adapted to optimise the use of multiple medicines and prescribe them according to the best available evidence.

The report suggests that for polypharmacy to be used more effectively doctors need much better training in the management of complex multi-morbidity and in polypharmacy.

And research needs to include people with several conditions, rather than selecting participants who have single conditions, says the report, adding that there should be national guidelines for multi-morbidity to match those for single conditions.

Systems, particularly for GPs, need to be improved so that they can flag up problematic polypharmacy, while patients’ medication should be regularly reviewed, and drugs stopped in cases of limited life expectancy, the report recommends.

A shift of emphasis in systems of medical care is needed away from increased specialisation towards a focus on multi-morbidity, says the report.

The report argues that polypharmacy needs to be better understood and defined, and accompanied by more concordance 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 so avoiding situations where medicines go unused or are wasted, suggests the report.

Integrated care is now widely accepted as the way forward in caring for people living with multiple, complex, long-term conditions, says the report. Appropriate polypharmacy, or medicines optimisation, now needs to be similarly accepted as one of the ways in which more co-ordinated care can be delivered, it concludes.

Lead report author Martin Duerden 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 intake in its entirety and how they are managing, especially if they have to take numerous medicines at different times in the day.”

He suggested that doctors should identify patients taking 10 or more drugs first and review their intake regularly, with a view to adding a medicine if the condition worsened, or scaling back or even stopping treatment, particularly at the end of life.

Royal Pharmaceutical Society spokesperson Neal Patel said: "We [the RPS] strongly believe it’s time to build a fully functioning multidisciplinary team in primary care to properly address the needs of the growing number of people with two or three or more long-term conditions.”

The needs of older people along with those who take many medicines, often for many different conditions, needed to be at the heart of this thinking, he said.

“There are already specialist pharmacists who work with community based teams including GPs, nurses, community pharmacists and social care professionals to make sure the needs of older, often housebound people are met,” he added.

“Too often patients receive treatments which, although complying with NICE guidance, do not match their own wishes and health goals. Now is the time to ensure that older people, as well as others taking many medicines, are given access to regular patient-centred medication reviews by pharmacists to improve their health and prevent adverse reactions,” he said.

Report: Polypharmacy and medicines optimisation: making it safe and sound

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