Frailty Care pathway
People get a great deal of benefit from medicines. Medicines extend healthy lives and can maximise the opportunities for improved wellbeing. The use of medicines in the NHS is driven by one of the most robust regulatory systems in the world and the evidence base upon which decisions are made is beyond comparison.
However, the evidence that is available to inform decisions is not equitably robust. People living with frailty, a condition of accumulated physical and mental deficits leading to a state of vulnerability, are not well represented in the trials that are used to populate the evidence. At the same time, having multiple deficits (co-morbidity) leads to people using multiple medicines, which has become known as polypharmacy. People with frailty are more susceptible to the side effects of medicines. Indeed, a person with frailty is six times more likely to be on 10 or more medicines and can be 300% more likely to be admitted to hospital as a result. The challenge CHC addressed is to help people with frailty get the best out of medicines, meet their needs and reduce the problematic polypharmacy that might cause harm.
Working in collaboration with clinical pharmacists to support deprescribing, the electronic frailty index (eFI) was used to identify eligible patients within primary care. GPs and primary care professionals attended the workshops and implemented the quality improvement (QI) approach in their Practices based on the Institute for Healthcare Improvement (IHI) QI model. The improvement measure was a reduction in the number of prescribed items for identifiable clinical reasons.
This resulted in case-based medication and polypharmacy reviews being implemented by GPs across Practices in Yorkshire and Humber resulting in a 6% reduction in average number of prescriptions per person. With eFI being accessible to 90% of England through electronic patient record systems, an expansion through the medicines optimisation programmes nationally could delivery savings and service improvement at scale.