Lots of people take several different medicines each day. Often this is completely appropriate, but it can sometimes cause problems. Taking lots of medicines could cause more side effects or make it difficult to remember which medicines to take.
Medication reviews are a chance for people to discuss their medicines with an expert (usually a doctor or pharmacist). People can discuss any issues with medicines and whether all the medicines are still needed. Together, they may decide to change or stop some of the medicines the person is taking.
UK guidelines recommend that having regular medication reviews is particularly important for some groups of people. This includes older people and people taking lots of medicines. Everyone should have equal access to medication reviews, but we do not know whether this is happening. In this project we will study a group of people aged 65 years or over to find out who had a medication review in 2019. This information could be used to help improve access to medication reviews for groups who are missing out.
Where medicines are causing problems, medication reviews are one possible way to reduce the number of medicines people are taking. In this study we will find out whether medication reviews do lead to changes in the number and types of medicines people are taking. The results could support the usefulness of medication reviews. Alternatively, the results could show medication reviews are not having an impact on the medicines people are using and may need improving.
We aim to determine whether there are systematic differences in access to medication reviews, and whether the numbers and types of medicines people are prescribed change after a medication review. Our study cohort will include people aged 65+ years in 2019 with at least one year of follow-up in CPRD prior to 2019. We will calculate the number and rate of people recorded as having a medication review in 2019 and compare the characteristics of people who did and did not have a medication review using Cox regression. We will compare demographic characteristics (including age, sex, ethnicity, deprivation), health and lifestyle indicators (smoking behaviour, alcohol use, body mass index), diagnoses (including mental health, cardiovascular, and other important diagnoses), and specific medicines prescribed (including anticoagulants and antipsychotics).
For those who had a medication review, we will count the maximum number of medicines with active prescriptions (‘polypharmacy count’) in the three months before and after the review. We will test for any change in polypharmacy count using Poisson regression and will include interaction terms with demographic characteristics and with the role of the individual performing the medication review. Finally, we will compare the drug substance and British National Formulary chapter of all medicines prescribed in the three months before and after the medication review to find which medicines were most often stopped or started.
This project is related to another ongoing study (protocol #20_000059) which will answer these questions in a population of people prescribed antidepressants. Together the results of these studies may highlight inequalities in access to medication reviews, which could help target approaches to improve access. They will also provide evidence for the impact of medication reviews on prescribing of multiple medicines (polypharmacy) and whether the current approach could be improved.
Medication reviews; Polypharmacy count; Drug substance of medicines prescribed; British National Formulary chapter of medicines prescribed
Ruth Jack - Chief Investigator - University of Nottingham
Ruth Jack - Corresponding Applicant - University of Nottingham
Amelia Taylor - Collaborator - University of Nottingham
Anthony Avery - Collaborator - University of Nottingham
Barbara Iyen - Collaborator - University of Nottingham
Carol Coupland - Collaborator - University of Nottingham
Darren Ashcroft - Collaborator - University of Manchester
Debbie Butler - Collaborator - University of Nottingham
Ralph Kwame Akyea - Collaborator - University of Nottingham
Roger Knaggs - Collaborator - University of Nottingham
Yana Vinogradova - Collaborator - University of Nottingham
Patient Level Townsend Index;Practice Level Townsend Index