A new model of prescribing for multi-morbid patients taking multiple prescribed medications
Medicines are an important part of modern health care. Medicines can make people feel better, function better, and live longer. With ever more medicines available to clinicians and patients, more people now use several medicines at a time (polypharmacy) and over a long period to improve their health.
But we are now seeing a new problem emerging – that of problematic polypharmacy. When the potential benefits of using multiple medicines is outweighed by the burden on patients associated with their use.
Many people recognise this problem and are working to improve how we use medicines. Medicines Optimisation refers to developing new systems of care to ensure safe prescribing of appropriate medicines to individuals. Deprescribing guidelines offer health professionals ways to safely discontinue medicines in people where the risk outweighs the benefit. Patients are, by necessity, working to adapt their medication regimes to fit with their daily lives in all sorts of ways.
But these ways of working don’t always have the same goal in mind. Patients, professionals and health systems don’t always agree on what is most important to think about when deciding about medicines. A recent report by the Kings Fund acknowledged that tackling problematic polypharmacy may require medicine and medical practitioners to compromise on the intended/ideal goals of medicines use – to better fit with what an individual patient wants, needs and can manage.
The aim of the project is to develop and test a whole practice complex intervention designed to enhance the use of clinical judgement to support individually tailored decisions about medicines use, to reduce the burden of problematic polypharmacy in patients experiencing vulnerability to disruption.
This project arose from PenCLAHRC’s 2014 Research Prioritisation process
Since early 2015 the project team have been conducting scoping work in order to produce a person-centred model of ‘optimal prescribing’.
The project team have also worked with colleagues from PenCHORD on a project to optimise polypharmacy using agent-based simulation.
The project team are currently preparing a bid for funding that will allow them to develop the model further.