The Health Innovation Network Polypharmacy programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Polypharmacy - A Pharmacist Led Medication Review Clinic, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Polypharmacy: A Pharmacist Led Medication Review Clinic
Background & Introduction
• Balsall Common Surgery is a large GP practice (approx. 13,000
patients) operating across two sites (Balsall Common & Meriden)
within Solihull Rural PCN
• The practice has a robust medication review system and high use
of Repeat Dispensing
• Medication Review appointments are face to face (but patients
can choose a telephone appointment instead), with a GP and 10
minutes in length
• GP conducting the review makes a clinical decision on the length
of time before the next review (usually 6 or 12 months)
Karen Kite, Lead Clinical Pharmacist, Solihull Rural PCN
Aim
• To set up a weekly pharmacist led Medication Review clinic at the practice
• The pharmacist is an Independent Prescriber with secondary care
experience in frailty and has recently completed the AHSN Polypharmacy
Action Learning Sets
• To provide longer, face to face Medication Review appointments (30
minutes)
• Older patients on multiple medicines to have their usual Medication Review
with the pharmacist (instead of a GP)
• Focus on Shared Decision Making conversations to reduce inappropriate
polypharmacy
Method
• Weekly pharmacist Medication Review clinic at Balsall Common
Surgery started in June 2023
• Notification sent to practice staff to inform them about the
availability of a new clinic and the patient type to book in to
appointments
• Patients requesting their usual medication review booked in to
clinics
• Named GP available for clinical support and Pharmacy Technician
available to support pharmacist with patient follow-up
Conclusions/Lessons Learned/Next Steps
• More work needed to provide a useful medication review service to the practice where the pharmacist sees the most appropriate patients
• Patients need encouragement to see a pharmacist rather than their usual GP for routine medication review
• More advertising, development of criteria or a different pro-active system required to book patients in to the clinic
• Face to face review needs to be encouraged
• More work needed to align routine medication review with Structured Medication Review (SMR) at the practice
• Start to use new AHSN patient materials in the clinic and obtain patient feedback
Case Studies
Mrs DA, 86 years, telephone review (housebound),
13 repeat medicines, contact Elderly Care consultant
seen privately, stop statin and gabapentin, pharmacy
technician follow-up home visit
Mrs PS, 88 years, telephone review with nephew
(POA), 6 repeat medicines, home visit with
pharmacy technician, remove medicine stockpile,
stop mirabegron and amlodipine, produce
medication checklist
Mr PL, 88 years, face to face review, 12 repeat
medicines, low BP and postural hypotension,
moderately frail, lives alone, uses walking stick, stop
tamsulosin after discussion with GP
Face to
Face
46%
Telephone
54%
Patients Reviewed
11 clinics (June – Sept 2023)
>75
years
62%
<75
years
38%
Age of Patients
28
17
11
<8
Medicines
>8
Medicines
>10
Medicines
Number of Medicines
per Patient
Results
19 medicines stopped (0.3 medicines/patient)
Examples of Medicines Stopped
Acknowledgements: Dr RJ Horsley, GP Partner, Balsall Common Surgery, Emma Taylor, Pharmacy Technician, Solihull Rural PCN