In this blog Steve Turner, MD of Care Right Now CIC, reflects on ways to reduce unnecessary use of medicines. Bringing together the need for more patient education with ways to negotiate the many rules and guidelines which can overwhelm us all.
My experiences and learning
I was speaking about the use of medicines at a conference recently when I mentioned that medicines are ‘over prescribed’. Although nobody questioned and challenged me on this I was troubled by my use of this expression. By saying medicines are prescribed too frequently it seems to me this can be interpreted as a bad reflection on the prescribers.
As I mentally mulled this over (I’m not a quick thinker) I came to the conclusion that the expression should be ‘medicines are overused’. After all it’s us (the patients) who go to our Doctors, Pharmacists and Nurses and us who accept their prescriptions. Therefore if we agree that people can rely too heavily on medicines, and there’s wealth of evidence for this, then we need to sort this out together.
My social enterprise company’s Patent Led Clinical Education work has shown us that a large section of the population is prescribed multiple medicines, with potential for interactions and increased side-effects. In addition it’s widely accepted that 50% of the population don’t take their medicines as prescribed. Add to this the sometimes forgotten fact that many people use alternatives (including street drugs), buy medicines over the internet and even borrow medicines from other people. It’s no wonder we have a problem.
The human and financial costs of over use of medicines are immense. We see this in our Patient Led Clinical Medicines Reviews. In our education sessions we have learned that many people don’t know what their individual medicines are for, and medicines prescribed purely to counteract the side-effect of another medicine can pile up.
In fact so far nobody who has attended one of our sessions (n=140) expressed a wish to take more medicines, and those who did express a view all said that they didn’t want to take medicines if they didn’t have to.
So what can we do together?
The next section looks at how to make sense of the vast amount of guidance available and describes why ‘trusted information’ is important in making decisions about medicines, including on when not to take them.
A second blog (part 2) focuses on three key areas; multi-morbidity; long term pain and the use of antipsychotics for people with learning disabilities.
Overwhelmed by the information, policies & guidance?
There’s an overwhelming amount of information and guidance on medicines, coming out on a daily basis. Even clinicians struggle to keep up and need help.
Two things are important in trying to make sense of this information overload.
- Making sure that the information you are looking at is from a ‘trusted’ source
- The need to differentiate between different sources of information e.g. primary research, systematic reviews, evidence summaries and media reports.
- Relating information on the use of a single drug or treatment to the real world.
The first two points will be covered in future blogs. Here and in the second blog, I’m concentrating on guidelines and their use.
The National Centre for Heath and Care Education [NICE] in England produces guidance, standards, indicators and evidence services covering health and social care. It’s not just about medicines. There’s a massive amount of trusted information on their web site, which covers:
- Conditions and diseases
- Health protection
- Lifestyle and wellbeing
- Population groups
- Service delivery, organisation and staffing
To get a feel for this one place to start is the NICE Pathways, where you can browse the topics, pick one and have the information presented in a diagram, where you can click on the headings for more information.
Recently there has been a move away from producing guidelines on a single illness or condition to a more holistic person based approach. This better reflects the complexities of real life, where it would often be a luxury to have just one illness with no complicating factors. NICE guidance on medicines optimisation, multi-morbidity clinical assessment and management, and patient experience in adult NHS services are good examples.
In addition NICE produces a document on Key Therapeutic Topics as part of the NICE Medicines and Prescribing Programme. This is a 128 page document covering 11 topics. In the next part of this blog I look at three of these topics, and summarise the key messages. The topics are:
- Multi-morbidity and polypharmacy (that’s where people are prescribed four or more medicines)
- Medicines optimisation in long-term pain
- Psychotropic medicines in people with learning disabilities whose behaviour challenges
I’ve chosen these from the 11 topics because they are amongst the most common areas we deal with in our patient led clinical education work.
Personal views of Steve Turner RGN; RMN; Ba (Hons); P.G. Dip Ed; MIHM
Steve is a nurse prescriber and NICE Medicines and Prescribing Programme Associate.
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For more on Care Right Now’s Patient Led Clinical Education work-streams click here: http://www.carerightnow.co.uk/projects/
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Last updated: 10/4/2017