In the UK, about 1-in-5 adults are being prescribed >5 medicines by their doctor. Prescription of multiple medicines is associated with increased side effects, hospital admission and medical error, so should be reviewed regularly. However, there is no standard approach to ensure medicines reviews are done well.
We will describe current practice and find out whether an enhanced approach developed by clinical pharmacologists (medicines specialists) could improve this. We will identify a group of patients prescribed a high number of regular medicines in 2012 and find out how many had a recorded medicines review. We will describe factors that predict whether a patient got a review, who carried out the review (e.g. doctor, pharmacist) and what changes were made as a result (e.g. stopping medicines, changing dose). We will investigate whether the presence of a review had any effect on subsequent hospital admission or death.
We will then use a sample of patient records to improve our enhanced medicines review taking account of interrelationships between multiple medicines and diseases. We will compare the potential benefits of the enhanced review to the actual benefits of standard reviews. If the enhanced review appears beneficial we will test it in clinical practice.
Patients taking multiple medicines are at increased risk of adverse reactions, hospital admission and medication errors, and commonly do not adhere to treatment. National guidelines recommend that medicines should be optimised by annual review.
Our primary aim is to use CPRD to describe current practice relating to medicines reviews in patients at high risk of medicines-related harm (adults aged >50 years taking >10 concomitant medicines). We will describe the prevalence and frequency of medicines reviews, place and practitioner, factors predicting who gets a review, and resulting changes (e.g. stopping inappropriate medicines). We will investigate relationships between presence of review and subsequent hospital admission or death.
Clinical pharmacologists are doctors with particular expertise in use of medicines. Our secondary aim is to develop an enhanced clinical pharmacology assessment to improve medicines reviews in patients with complex health needs, taking into account relationships between multiple medicines and diseases. Potential benefits will be determined in 200 randomly selected patients from the initial cohort by comparing medication changes recommended by the enhanced review to those resulting from the standard review. Results will provide a basis for further exploration of the role of clinical pharmacologists in decision-making for patients with complex co-morbidity and polypharmacy.
The health outcomes in our study will primarily come from the linked dataset. Our primary outcome will be emergency hospital admissions. We will also explore the sub-group of emergency admissions for Ambulatory Care Sensitive Conditions (ACSC), which are thought to be potentially preventable with better clinical management. Other outcomes we will explore are: all-cause mortality and number of primary care consultations.
Emma Baker - Chief Investigator - St George's, University of London
Iain Carey - Corresponding Applicant - St George's, University of London
Chris Threapleton - Collaborator - St George's, University of London
Derek Cook - Collaborator - St George's, University of London
Fay Hosking - Collaborator - St George's, University of London
Henry Fok - Collaborator - St George's, University of London
Stephen DeWilde - Collaborator - St George's, University of London
Tess Harris - Collaborator - St George's, University of London
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation