Resources to tackle polypharmacy

Problematic polypharmacy affects a patient’s quality of life and can have a negative impact on their health. It is often entirely preventable. As more people live longer with multiple long-term health conditions, the number of medicines they take often increases. This can create a significant burden for the person trying to manage multiple medicine at the same time, and in some cases, it can cause harm.

In England, the NHS primary care system dispenses over one billion prescriptions every year. In September 2023, there were 993,019 people who received 10 or more medicines of which 402,462 of them were aged 75 or over. This is problematic because:

• a person taking 10 or more medicines is three times more likely to suffer harm.
• 16.5% of unplanned hospital admissions are due to adverse drug reactions (ADRs) and polypharmacy.
• there has been a 53% increase in the number of emergency hospital admissions caused by ADRs.

  Structured Medication Reviews

NHS England describes a structured medication review (SMR) as an evidence-based and comprehensive review of a patient’s medication, considering all aspects of their health. In a structured medication review, clinicians and patients work as equal partners to understand the balance between the benefits and risks of and alternatives to taking medicines. The shared decision-making conversation is led by the patient’s individual needs, preferences and circumstances.

NHS England describes the benefits of SMRs for patients taking multiple medication as:

• Improved experience and quality of care by involving patients in the decision-making process and helping them better understand the medicines they take.
• Less risk of harm from medicines (e.g. adverse drug events, side effects, hospitalisation or addiction)
• Better value for local health systems (e.g. reduced medicine waste).

The three core principles of this programme

The Health Innovation Network’s national polypharmacy programme in built on three core principles aimed at supporting local systems in addressing problematic polypharmacy.

• Population health management
• Clinician training
• Patient engagement

These three principles are also supported by a Yorkshire and Humber polypharmacy community of practice focusing on problematic polypharmacy within local areas.

  Population Health Management

Through a series of national webinars, education and training, the programme supports the routine use of NHSBSA Polypharmacy Prescribing Comparators to identify and prioritise patients, promoting shared decision-making in structured medication reviews.

See dates for forthcoming webinars and book your place

  Clinician training

Training through evidence-based polypharmacy Action Learning Sets (ALS) is 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.

Get details of our upcoming ALS cohorts and book your place

  Patient Engagement

We are also working with patients and the public to drive regional testing and evaluation of public-facing initiatives to change public perceptions of prescribed prescriptions and encourage patients to be open about their medication concerns and expectations.

Patients have access to a range of patient information materials in 11 different community languages to prepare for their medication review including a patient invitation letter for a SMR, the Me and My Medicines charter, which aims to improve conversations between patients and their clinician, and the ‘Safely stopping medicines’ leaflet to help communicate medication changes after an SMR. All resources are also available in easy-read and audio format from this link.

To support the use of the patient resources Health Innovation Yorkshire & Humber has worked with local Integrated Care Boards (ICB) teams to produce two SMR videos.

Structure medication review video to support clinicians

This video is for clinicians. It provides an example of a good SMR, with a focus on the shared decision-making process, and supports the education of staff who are less experienced or new to conducting medication reviews in general practice. The video is also helpful to share with other members of the primary care team (e.g. care navigators) to help them understand what SMRs involve. 

Structure medication review video to support patients

This video is for patients who take multiple medications and may require an SMR. It shows what to expect and encourages patients to articulate their needs, preferences and circumstances as part of the shared decision-making process.

Recordings of previous masterclasses are available below