Clinical Director – Improvement Capability, NHS Improving Quality
As science advances, we have become increasingly reliant on medication, not only to treat disease but also to prevent illness and manage our health. Over a third of 75-year-olds are now taking at least four different prescribed drugs – and that figure continues to rise.
In most respects this is of course a good thing. More and better drugs are significant factors in our increased life expectancy and the higher quality of life that many people with long-term conditions can now expect.
But with this comes a greater risk they will be used inappropriately or unsafely. And no one can pretend that at the moment we are making the best possible use of the billions of pounds spent each year on medications in the UK.
The risk to safety has to be the biggest concern. Over half a million medication incidents were reported to the National Patient Safety Agency between 2005 and 2010 – of which 16% involved actual patient harm. GPs made an estimated 1.7 million serious prescribing errors in 2010 and a care homes study found that over two thirds of residents were exposed to one or more medication errors.
The situation is further complicated when medicines are not taken as intended. This is surprisingly common and the evidence suggests that adherence rates can be improved where we better engage with patients about their medicines.
And then there is the prodigious waste. Around £300 million of medicines are wasted each year of which £150 million is avoidable. And at least 6% of emergency re-admissions are triggered by avoidable adverse reactions to medicines (1).
One CCG support pharmacist recently reviewed a patient at high risk of hospital admission who was taking no less than 35 different medicines. The pharmacist recommended a series of measures, including reducing some medication and stopping others that were no longer needed or were contraindicated. The result was less medication, a better quality of life and a reduced risk of hospitalisation.
It is clear we cannot go on like this. Professionals in both hospital and the community have to find out more about patients’ experience of taking medication and then support them to get it right.
At the same time commissioners need to have a clearer overview of what is happening across their patch and where the problems lie. And that is why the new medicines optimisation dashboard is so important.
Produced by our colleagues at NHS England, the dashboard, which is still in prototype form, brings together a range of data relating to the use of medicines across England, broken down by area, CCG and hospital trust.
The dashboard is not a performance measurement tool and does not contain targets; rather it acts as a guide and prompt for commissioners. It covers a range of indicators, including medication errors, repeat prescriptions, ‘never’ events, electronic prescribing and New Medicine Services uptake.
It is hoped that commissioning bodies will use this information to explore the pharmaceutical ‘health’ of their local populations and how patients can be supported to make best use of their medicines.
At heart this is very straightforward. It is about ensuring that the right patients get the right choice of medicine at the right time. And it offers a genuine win-win opportunity. By focusing on what patients need we can ensure their medication is more effective while at the same time cutting waste and saving resources.
But that will require a step change from how things are done now. Healthcare professionals will need to work together to individualise care, manage outcomes more carefully and review people’s medications more frequently as well as giving patients ongoing support. Additional information can be found on the Royal Pharmaceutical Society website.
This should all be based on four key principles –understanding the patient’s experience, finding the best choice of medicines, ensuring medicine use is as safe as possible and making medicines optimisation part of routine practice.
That could involve stopping some medicines and starting others as well as considering lifestyle changes and non-medication therapies that may reduce the overall need for medication. Ultimately, this is about helping patients to take ownership of their own treatment.
The medicines optimisation dashboard offers the tools to allow this to happen. It shows CCGs where they need to focus their attention to help patients get the best from their medication. The mechanism is in place – now it is up to commissioners to use it for the benefit of their patients, and the service.
- Pirmohamed M, James S, Meakin S, Green C, Scott A K, Walley TJ, Farrar K, Park BK, Breckenridge AM. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–19.