Deprescribing: Fashion Accessory or Fig Leaf?

Deprescribing is the general practice fashion accessory that no prescriber can be seen without. However, it is in danger of becoming a "fig leaf" substitute for the entire medication review suite.

The scale of repeat prescribing--time for an update.

BACKGROUND: The NHS spends billions of pounds annually on repeat prescriptions in primary care, but data on their extent and use is out of date. Understanding the scale of repeat prescribing and for whom it is prescribed is important for the NHS to plan services and develop policies to improve patient care. METHOD: Anonymous data on prescription numbers and practice population demographics was obtained from GP computer systems in a large urban area.Searches were conducted in November 2011 to identify the numbers of repeat items listed on individuals' repeat lists by sex and age.The proportion of all prescription items issued as repeats was identified by conducting searches on items issued as repeat and acute prescriptions. RESULTS: In the year of study 4,453,225 items were issued of which 3,444,769 (77%) were repeats (mean 13 items per patient/annum) and 1,008,456 (23%) acute prescriptions (mean 3.9 items per patient per annum). The mean number of repeat Items per patient was 1.87 (range 0.45 ages 0-9 years; 7.1 ages 80-89 years). At least one repeat medicine was prescribed to 43% of the population (range 20% for ages 0-9; over 75% for ages 60+). CONCLUSION: A significant proportion of the population receive repeat prescriptions and the proportion increases with age. Whilst the proportion of repeat items to acute items has remained unchanged over the last two decades the number of repeat prescriptions items issued has doubled (from 5.8 to 13.3 items/patient/annum). This has implications for general practice workload, patient convenience, NHS costs and risk.

The recording of drug sensitivities for older people living in care homes.

AIMS: The aims of this study were to determine the recording of drug sensitivities of elderly care home residents, to describe the nature of sensitivities and to identify and describe discrepancies in the documentation of drug sensitivity status in general practices, pharmacies and care homes. METHODS: A random sample of residents within a purposive sample of care homes (nursing and residential) was selected. A clinical pharmacist inspected the GP medical record, the medicines administration record, and the care home record for each resident to identify drug sensitivities and discrepancies between records and to describe the nature of the recorded sensitivities. RESULTS: The records of 121 residents in 31 care homes were studied. Thirty-one (26%) residents had at least one documented drug sensitivity in one of the sources inspected, with 48 sensitivities in total recorded. There was no description of the nature of the sensitivities recorded in 39/48 (81%) cases. The number of sensitivities recorded on the medicines administration record, care home record and the GP record were 3 (6%), 29 (60%) and 35 (73%), respectively. Only two sensitivities were simultaneously recorded on all three records. CONCLUSIONS: It was of concern that over 90% of drug sensitivities were not recorded on the medicines administration record which is the final checking document when administering medication. The reason for this was that the dispensing pharmacy was responsible for generating the medicines administration record; however, drug sensitivity status is seldom shared between the GP and the dispensing pharmacy. Printing sensitivities on prescriptions would help to resolve this.

Is medication review by primary-care pharmacists for older people cost effective?: a narrative review of the literature, focusing on costs and benefits.

The nature, definition and history of medication review of long-term conditions and treatment is discussed. A literature search for studies of medication review of older people in primary care by pharmacists yielded 16 reports of studies in English, and only ten of these were randomized controlled trials. Extracting meaningful conclusions from the data was problematic because of variations in the nature of the review described, the populations studied, the outcome data measured and the evaluation criteria used. There is a dearth of economic measurement and often inadequate descriptions of the interventions performed. Those interventions that were described in detail varied in the skills, training and approach of the pharmacists. Therefore, there was no possibility of aggregating results of studies, and the review conclusions are based on trends and impression rather than meta-analysis. There was no suggestion in any reports that patients were harmed by the interventions, and some consistency in suggesting that falls and hospital admissions might be reduced with modest cost savings, at least in terms of drug costs. No studies reported a benefit in terms of mortality, mental capacity or activities of daily living. The authors conclude that clinical medication review is probably of value and may be cost effective, but propose a large-scale, long-term, multicentre, collaborative clinical trial with carefully chosen (and clearly described) interventions and outcome measures to confirm this.