A poster at last week’s RCGP annual conference highlighted the danger of hyperpolypharmacy, the use of ten or more medications, in the population aged over 75. A review of a single GP practice by clinical pharmacists from Interface Clinical Services reviewed the medical care of over 1,800 patients over 75 and found that in the past 12 months on average each patient had 13.93 GP consultations and were prescribed 6.17 medicines.
The presentation further showed that 364 patients were on obsolete therapies, 199 patients were not taking their drugs as recommended, and 39 patients experienced side effects or an adverse drug reaction.
As a result of the review, 640 patients had their medication stopped, 121 patients were sent to their GP for further review, and 89 patients had their dose reduced.
It is estimated that Interface’s medications interventions alone resulted in over £18,000 in savings to the NHS, and the overall saving from the review which included preventing hospital admissions, was over £192,000.
A total of 38 level 3, 109 level 2 (equivalent to 11 level 3), and 1,080 level 1 interventions were identified. This equates to a total of 49 level 3 interventions, and 49 hospital admissions avoided. A list of drug classes/types within the level 3 and level 2 interventions includes inhalers, glucose lowering agents, warfarin, antihypertensive, antiplatelet, bisphosphonates, non-VKA, PPIs, nitrates, antidepressants, statins, and antimuscarinics.
A cost avoidance figure of £2,200 is attributed to each potentially saved hospital admission. The ‘possible’ nature of the impact of the level 2 interventions is also attributed a cost avoidance value by equating a total of ten level 2 interventions to be the equivalent to one level 3 intervention. It is therefore estimated that a total of £107,800 in savings to the NHS was made as a result of Interface’s review.
Any recommended changes to a patient’s medication were discussed in a face-to-face consultation with the Interface pharmacist and subsequently reviewed by the patient’s GP.
Interface began this study in response to findings from the Health and Social Care Information Centre (HSCIC) that people aged 65 or over account for one in six of the population, but one in two hospital beds, while people aged 85 or over account for one in 44 of the population and one in six hospital beds. Four out of five people aged 75 or over take at least one prescribed medication, and patients on multiple medications are more likely to suffer drug side effects and adverse reactions. Adverse reactions and side effects from drugs account for between 5% and 17% of all hospital admissions.
There is a clear and steady increase in the number of patients admitted to hospital with drug related side effects. A person taking 10 or more medications is 300% more likely to be admitted to hospital. By conducting this kind of clinical assessment in primary care practices, Interface is helping to reduce drug-related adverse events in over 75s and decrease the burden that they place on secondary care services.
The GP from the practice where the review took place commented:
I am very pleased to have been involved with this review. Our practice does not have the resources to carry out this kind of work ourselves, and Interface helped us to highlight several important issues with prescribing habits and obsolete drugs that we can continue to monitor in the future.