Polypharmacy and medicines optimisation: Making it safe and sound

The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible care is available to all. iii List of tables and figures iv About the authors and acknowledgements v Foreword vii Key points ix Introduction 1 What is polypharmacy? 1 Why polypharmacy is an important challenge 2 1 'Measuring' polypharmacy 5 Defining polypharmacy according to numbers of medicines 5 Tools to assess appropriateness of prescribing in polypharmacy 5 Proposed pragmatic approach for identifying higher-risk polypharmacy 7 2 The epidemiology of polypharmacy 9 Polypharmacy in primary care 9 Polypharmacy in hospitals 10 Medication use in care homes 11 Polypharmacy in other countries 11 Multi-morbidity and ageing as driving factors 13 3 Medicines optimisation and polypharmacy 17 Evidence for improving medicines management in polypharmacy 17 Reducing medication errors 19 Polypharmacy and use of monitored dose systems 19 Medication review and repeat prescribing 20 Polypharmacy at discharge and medicines reconciliation 21 Suggestions for improving care in the context of multi-morbidity 22 Medicines management in care homes 23 Polypharmacy and stopping medicines 24 Medication waste, medicines management and polypharmacy 25 4 Evidence-based polypharmacy 27 5 Prescribing and polypharmacy in older people 29 Are drugs for older people effective? 29 Medication reviews, polypharmacy and older people 30 6 Polypharmacy and the patient experience 32 7 Summary 33 8 Case examples and practical tips 34 9 Resources 39 References 49 Contents iv Tables Table 1 Prescribing indicators used to identify problematic or inappropriate polypharmacy 6 Table 2 Year-on-year change for drugs used to treat diabetes, England, 2005/6 to 2011/12 14 Table 3 Reducing relative and absolute risk through polypharmacy 27 Table 4 The Hypertension in the Very Elderly Trial (HYVET) 30 Figures Figure 1 Prescription items dispensed per head of population in UK countries, 2011/12 2 Figure 2 Trends in prescription items dispensed, Figure 8 Selected co-morbidities in people with coronary heart disease, diabetes, COPD or cancer in the most affluent and most deprived areas of Scotland 16 v Martin Duerden has worked as a part-time GP in Conwy, North Wales since1999. In 2003 he became Medical Director at Conwy Local Health Board, reorganised to Betsi Cadwaladr University Health …