Polypharmacy: a UK perspective_Dr Rupert Payne
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Polypharmacy: a UK perspective: a presentation by Dr Rupert Payne, University of Bristol, Centre for Academic Primary Care.
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Polypharmacy: a UK perspective_Dr Rupert Payne
- 1. Centre for Academic Primary Care Polypharmacy: a UK perspective @DrRupertPayne r.payne@bristol.ac.uk
- 2. Centre for Academic Primary Care 3000drugs
- 3. Centre for Academic Primary Care
- 4. Centre for Academic Primary Care
- 5. Centre for Academic Primary Care
- 6. Centre for Academic Primary Care Polypharmacy
- 7. Centre for Academic Primary Care Prescribing Cost Analysis, England £9 billion >1 billion items
- 8. Centre for Academic Primary Care Guthrie B, 2012
- 9. Centre for Academic Primary Care
- 10. Centre for Academic Primary Care Age and multimorbidity Guidelines and EBM Systems and processes
- 11. Centre for Academic Primary Care ONS, 2015
- 12. Centre for Academic Primary Care Barnett K, Lancet 2012
- 13. Centre for Academic Primary Care Payne RA, Eur J Clin Pharmacol 2014 20s 30s 40s 50s 60s 70s 80s 90s Age (years) 0 1 2 3 4 5 6+ Number of conditions
- 14. Centre for Academic Primary Care
- 15. Centre for Academic Primary Care Systems Processes
- 16. Centre for Academic Primary Care So what?
- 17. Centre for Academic Primary Care QoL
- 18. Centre for Academic Primary Care Tomlinson L, PLOS One 2013 14%
- 19. Centre for Academic Primary Care Patientexperience p≤0.001 for each itemPayne RA, unpublished
- 20. Centre for Academic Primary Care Polypharmacy is not all
- 21. Centre for Academic Primary Care Payne RA, Br J Clin Pharmacol 2014
- 22. Centre for Academic Primary Care Definition?
- 23. Centre for Academic Primary Care “…medicines use has been optimised and … prescribed according to best evidence. The overall intent … to maintain good quality of life, improve longevity and minimise harm…” King’s Fund, 2013 Appropriate polypharmacy
- 24. Centre for Academic Primary Care “…prescribe inappropriately … or where intended benefit … not realised … not evidence-based … risk of harm from treatment is likely to outweigh benefit … one or more [other issues]” King’s Fund, 2013 Problematic polypharmacy
- 25. Centre for Academic Primary Care
- 26. Centre for Academic Primary Care Measure?
- 27. Centre for Academic Primary Care Inappropriate prescribing criteria Explicit vs. Implicit
- 28. Centre for Academic Primary Care Identifying polypharmacy? • ≥10 medicines • 4 to 9 medicines and – Inappropriate criterion – Non-adherence – Single major diagnosis – End-of-life care
- 29. Centre for Academic Primary Care Consensus Implementation Validation Epidemiology
- 30. Centre for Academic Primary Care
- 31. Centre for Academic Primary Care
- 32. Centre for Academic Primary Care Cochrane systematic review (Patterson 2014) • 12 studies, older patients • Multi-faceted complex interventions • Questionable evidence of benefit
- 33. Centre for Academic Primary Care Patient Profession Setting Point of care Method
- 34. Centre for Academic Primary Care Patient Profession Setting Point of care Method
- 35. Centre for Academic Primary Care •10+ drugs •Admission risk •Frailty
- 36. Centre for Academic Primary Care
- 37. Centre for Academic Primary Care Patient Profession Setting Point of care Method
- 38. Centre for Academic Primary Care Pharmacists IT feedback Face-to-face Education
- 39. Centre for Academic Primary Care Pharmacists Doctors
- 40. Centre for Academic Primary Care Patient Profession Setting Point of care Method
- 41. Centre for Academic Primary Care
- 42. Centre for Academic Primary Care Opportunistic Planned
- 43. Centre for Academic Primary Care Betteridge TM, Int Med J 2011
- 44. Centre for Academic Primary Care Patient Profession Setting Point of care Method
- 45. Centre for Academic Primary Care
- 46. Centre for Academic Primary Care Barnett N et al, 2015 Medication review
- 47. Centre for Academic Primary Care
- 48. Centre for Academic Primary Care Deprescribing “The process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes” Reeve E, Br J Clin Pharmacol 2015
- 49. Centre for Academic Primary Care
- 50. Centre for Academic Primary Care Harms Scott IA, JAMA Intern Med 2015 Patient centred Review Eligibility Prioritise Implement Monitor
- 51. Centre for Academic Primary Care Deprescribing evidence? • Patients? • Approach? • Effective? • Safety?
- 52. Centre for Academic Primary Care Supportfor deprescribing ?
- 53. Centre for Academic Primary Care • Resources • Measurement • Clinical • Systems • Interventions Improving polypharmacy
- 54. Centre for Academic Primary Care Evidence-based interventions • Proactive and reactive • Better IT • Patient centred • Pharmacists and GPs working together • GPs taking more responsibility • Empower clinicians
- 55. Centre for Academic Primary Care A necessary evil?