Prescribing Quality Scheme Polypharmacy and Deprescribing review (2019)

Camden CCG

Project Summary

Camden CCG Prescribing Quality Scheme Polypharmacy and Deprescribing review aims to address problematic polypharmacy, and through use of an EMIS medication review template improve the quality of medication reviews to address polypharmacy and ensure patient involvement in decision making. The review supports prescribers to:

• Identify patients who may not be obtaining optimal benefit from their medicines, particularly those patients with multimorbidity.
• Review medication and improve patients’ quality of life whilst maintaining control of chronic conditions; this may include stopping, starting or changing a patient’s medication.
• Ensure patients are given opportunities to discuss their values, priorities and goals leading to the development of individualised management plans which are reviewed and updated as needed.
• Ensure patients understand the value of a medication review and what questions they can ask in a review to get optimal gain from one.
• Conduct comprehensive face-to-face clinical medication reviews in identified patient cohorts with a focus on reducing harm and maximising benefit from medicines by addressing multimorbidity and inappropriate polypharmacy and giving consideration to stopping or withdrawing inappropriate or ineffective medicines.
• Improve the quality of medication reviews undertaken and EMIS recording and coding of them.
• Reduce wastage of medicines.
• Utilise shared decision making to involve patients in decisions about their medicines.

Outcomes:

425 face to face medication reviews were conducted with patients on 10 or more medicines. 323 patients had shared decision making and an individualized management plan agreed following review. 44% of patients having a face to face review had medication stopped or changed.

139 patients with medicines identified in a group for potential for deprescribing had a face to face medication review. 133 patients had shared decision making and an individualized management plan agreed following review. 35% of patients having a face to face review had medication stopped or changed.

GP practice action plans include: clinical meetings, shared decision making within practice processes, training on use of templates, medication review processes developed / embedded, medicines stopped / changed, patient education and empowerment.