Keynote 3 – Reducing problematic polypharmacy – using Action Learning Sets to optimise sustainable medicines use

• Section 1 – Introductory Statements and Governance: Statements – 1.1, 1.3
• Section 4 – Clinical Pharmacy: Statements – 4.1, 4.2, 4.3, 4.6
• Section 5 – Patient Safety and Quality Assurance: Statements – 5.1, 5.5

Abstract

Each month in England roughly 1 million people receive 10 or more medicines. Almost 400.000 of them are aged 75 or over and over 100.000 of them are aged 85 or over. Risk of errors and risk of hospitalization increase with age, multimorbidity and polypharmacy. Much of the harm from polypharmacy is preventable / avoidable.

While people can easily understand the problem with the potential overuse of medicines, many clinicians struggle with how to address it with individuals they see within their clinics, wards and pharmacies. Over the past 5 years, we have developed the Polypharmacy Action Learning Sets, aimed at supporting General Practitioners, Pharmacists and other prescribers to improve their skills and confidence to tackle polypharmacy via structured medication reviews with patients.  Built on a model funded by the Health Foundation in the Yorkshire and Humber area of England, an independent evaluation by Southampton University of five years of this work led to the commissioning of a national scale-up program across the whole of England.

This keynote will outline how the Action Learning Sets aim to get a better understanding of why medicines that are not clinically appropriate are not always stopped. They aim to:

1. Understand from delegates the barriers (practical and cognitive) to systematically stopping medicines that are no longer warranted in older patients
2. Explore with delegates how we can address some of these barriers within General Practice and support better medication reviews
3. Provide a deeper understanding of shared decision making and how to incorporate this into all medication reviews (especially for older people with multimorbidity)
4. Outline some of the many tools available to help prescribers to conduct successful medication reviews
5. Replicate the impact already shown in the independent evaluation

This keynote presentation will:

• Tell the journey of the Polypharmacy Action Learning sets over the past 5 years in England
• Share our key learning to date and how you can apply this to your practice
• Outline the impact that these ALS have had on patient care and how they have improved clinicians’ confidence in tackling problematic polypharmacy
• Address where improvements in polypharmacy can support efforts to improve environmental sustainability

Learning objectives

After the keynote address, delegate will be able to:

• Describe the features of an Action Learning Set
• Discuss how to use this methodology to identify skills gaps and learning needs within teams and individuals
• Describe the different techniques for exploring the values and preferences that a patient holds
• Recognise the cognitive and practical barriers to stopping medicines both safely and appropriately

Educational need addressed 

This keynote addresses how to identify the skills gaps for individuals in order for them to undertake effective and successful medication reviews, fully taking into account the person’s values and preferences regarding their medicines’ choices.

Keywords 

Polypharmacy, shared decision making, workforce education and training, structured medication review, multidisciplinary team working