Optimising Medicine Use, Professor Graham Davies, King's College London

1. OPTIMISING MEDICINES
USE
GRAHAM DAVIES
Professor of Clinical Pharmacy & Therapeutics
Institute of Pharmaceutical Science
King’s College London

2. Learning outcomes
1. Describe the problems commonly associated with the use of
medicines
2. Explore the common causes of adverse drug reactions
3. Describe how pharmacists can contribute to optimising
medicines use

3. Typical patient journey
Patient Experiences
Symptoms or routine
health check
Diagnosis Seek health care
Intervention (referral, procedure or medicine)

4. Medicines:
the most common intervention
NHS Budget:
• 1999/2000 £40 billion
• 2011-12 £105 billion
• Drug Expenditure 15% of budget

5. Medicines in perspective
• Explosion of anti-infective agents to target range of infections e.g. range
of antibiotics; HIV
• Positive impact of low dose aspirin on mortality following a heart attack
(1980s)
• The significant benefit of ACE Inhibitors to treat heart failure (1987)
• Impact of statins to control blood cholesterol (1990s)
• Expansion in the range of chemotherapy agents

6. Evidence based treatment

7. “One of the greatest hazards is the use of potent drugs
is their
inherent toxicity……
…..the dangers of the drug appear to be greater now
then ever before.”
David Barr MD; Hazards of modern diagnosis and
therapy – the price we pay. Frank Billings Memorial
Lecture.
J Am Med Assoc 1955;159 (15): 1452-1456

9. Problems caused by medicines

10. Adverse drug reactions causing
hospital admission
1. 6.5% of all admissions due to an ADR
2. Elderly patients 3-4 times more likely to be admitted with
ADR
3. 4% of hospital bed capacity
4. 0.15% fatality
5. Drug-interactions responsible for 1 in 6 ADRs
6. 72% were preventable
7. Cost to NHS £466 million/year
Pirmohamed, M., et al. Adverse drug reactions as cause of admission to hospital:
hospital: prospective analysis of 18 820 patients. BMJ, 2004. 329(7456): 15-9.
15-9.

11. Adverse drug reactions and the
elderly
Tangiisuran et al Drugs in Aging 2

12. Which medicines cause harm?
Safety in Doses. National Patient Safety Agency

13. Non-adherence to medicines
1World Health Organization Report 2003.
2 Horne et al. Concordance, adherence and
compliance in medicine taking. NIHR SDO 2006.
3 NICE. Medicines concordance & adherence:
involving adults and carers in decisions about
prescribed medicines 2008/9
Recent reports:
• Estimated that between
30 -50% medicines
prescribed for long term
illnesses are not taken as
directed.
• Cost associated with
wastage – not only the
medicine but the time of
healthcare staff.

14. Sources of medication problems
- multifactorial
• Prescribing - selecting the wrong or inappropriate drug, often
at the wrong dose for the patient,
• Co-prescribing – interacting medicines, complementary
therapy or alcohol
• Lack of patient education - information relating to:
– What do they understand about their disease?
– Do they understand the benefits of therapy?
– What concerns do they have about their prescribed
medicines?

15. ROLE OF PHARMACISTS IN
MANAGING MEDICINES

16. Pharmacists
– optimising medicines use

17. Identifying medication problems
• Knowledge of patient – is there anything about this patient
that concerns me?
• Knowledge of medicine – is there anything about this
medicine that concerns me?

18. Patient factors
• Patient Characteristics
– Age, ethnicity, gender
– Height, weight, BMI
– Pregnancy & breast feeding
• Co-morbidities (for example)
– Asthma and hypertension
– Arthritis and peptic ulcer disease
– Allergy status and infection
– Pain and renal disease
• Function and cognitive factors
– Mobility, balance, sight, swallowing
– Memory, comprehension
• Social and environmental factors
– Lifestyle, home environment and
family support
– Support services available
• Patient’s perception of drug
therapy

19. Medicine factors
• Toxicity Factors
– Drug interactions, complementary
medicines,
– Allergy status, contraindications,
– Adverse reaction profile
– Therapeutic index of medicine
• Drug factors
– Renal and hepatic function
• Evidence of efficacy
supporting medicine
• Response to current and previous
drug therapy
– Did the treatment work?
– Did the patient experience any
problems?

20. The care process
Establishing a therapeutic relationship - a continuous process
PATIENT
ASSESSMENT
CARE PLAN EVALUATION

21. Use a range of information to:
• Identify actual and potential drug related problems
• Resolve actual drug related problems
• Prevent potential drug related problems

22. Summary
• Medicines are beneficial but can also cause harm
• Society needs a gatekeeper who manages medicines for
society - seen as the drug expert - the pharmacist
• Pharmacists must adopt a patient focused approach to
identifying and resolving medication related issues
• Understanding the aims and process which underpin the
process of identifying medication - related problems is
essential to delivering safe and effective care

23. OPTIMISING MEDICINES
USE
GRAHAM DAVIES
Professor of Clinical Pharmacy & Therapeutics
Institute of Pharmaceutical Science
King’s College London