Safer Prescribing for Frailty A Story of Polypharmacy Reduction in General Practice : Health foundation report
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 our project is trying to address is to help people with frailty get the best out of medicines, meeting their needs and reducing the problematic polypharmacy that might cause harm.
We provided an innovative primary care quality improvement programme combining behaviour change theory with Institute for Health Care Improvement (IHI) method of quality improvement.
The 12 GP practice teams in our Safer Prescribing for Frailty project achieved a 6% reduction in the average number of prescription items prescribed to people with frailty. This was achieved by embedding holistic medication review, targeted at problematic polypharmacy, which normalised shared decision making and improved the quality of the care provided