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 SMR reviews in outpatient bone health clinics, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Inappropriate polypharmacy is recognised as a contributing factor
towards adverse outcomes in frail patients.
Current efforts at national level are centred around primary care initiatives
in completing structured medication reviews (SMR) where shared
decision making takes place with open discussion around risks and
benefits of treatments.
The aim of this review was to assess whether recommendations
for discussion in SMR have been adopted for patients attending frailty
bone health clinic led by Consultant Pharmacist, in hospital outpatient
setting.
Polypharmacy reviews in outpatient clinics -
beginning the structured medication review in bone health clinic
Đula Alićehajić-Bečić, Consultant Pharmacist Frailty, Wrightington, Wigan & Leigh NHS Teaching Trust
Discussion
Further exploration of cases where recommendations were not
adopted will take place via interviews with GP pharmacists
We have introduced service of Advice and Guidance which aims
to capture queries from primary care practitioners – it is felt that
this will enable us to communicate more effectively and allow us to
support colleagues with complex polypharmacy queries
Royal Pharmaceutical Society, Polypharmacy: Getting our Medicines Right
Polypharmacy: Getting our medicines right (rpharms.com)
Introduction
Retrospective analysis of notes
was undertaken in a sample of 30
patients reviewed in bone health
outpatient clinic in the period
01.09.22 - 28.02.23, who were on
at least five medications, were still
alive six months post review and
where suggestions with regards to
actionstodiscussduringastructured
medication review were made.
Recommendations were made based upon individual fracture and
falls risk, frailty level, identification of prescribing cascades and using
clinician judgement with respect to issues highlighted by the patient
during the consultation.
Utilising hospital electronic records and GP records, the outcome
for each medication which was suggested for review was
captured, alongside data on frailty, age, number of medicines at
OPD appointment vs number of medicines 6 months after and
anticholinergic burden reduction.
Royal Pharmaceutical Society, Polypharmacy: Getting our Medicines Right
Polypharmacy: Getting our medicines right (rpharms.com)
Method
• 5 male and 25 female
• Mean age 79.7years
• Mean CFS 5.8
• Mean number of medication taken at OPD review 11.8
• Mean number of medication taken 6 months after OPD review 10.4
• Mean reduction in anticholinergic score -0.9
Results
• Drug class most often suggested for consideration of deprescribing
were tricyclic antidepressants
• Overactive bladder drugs were the next most common – due to no
longer being valuable or increasing patient’s risk of falling
• Other common groups for discussion included cardiac medication,
opioids, statins and CNS medicines
• A number of possible prescribing cascades were identified i.e.:
fludrocortisone + furosemide, amlodipine + furosemide and
amlodipine + midodrine
• From total 65 recommendations made, 39 were completed (60%)
0 2 4 6 8 10 12 14
Tricyclic antidepressants
OAB drugs
alendronic acid
opioids
statins
ISMN
prescribing cascade
thiazides
zopiclone/zolipdem
alpha blockers
antiemetics
Antisychotics
calcium channel blockers
PPI
pregabalin
sedating antihistamines
supplements (folic/iron)
ACEIs/angiotensin 2
antispasmotic
benzodiazepines
betahistine
mirtazapine
sulphonylurea
Number of recommendations made for discussion at structured
medication review (n=65)
Colour
Yellow
Orange
Blue
Brown
Purple
Red
Green
Drug Class
Cardiac
CNS
Bladder
Bone
GI
Prescribing cascade
Other
Outcome from Polypharmacy review recommendations 6 months after clinic appointment
(n=30)
Completed fully
Partially completed
Not completed
Conclusion
Starting a structured medication review in outpatient clinic has the
potential to reduce the risk of adverse events and improve outcomes
for patients.
Furtherworkwillbeundertakentoascertainreasonsfornotadopting
the recommendations and continuous collaboration with primary
care colleagues will continue to address problematic polypharmacy.