A new government review has called for more research to investigate the reasons why overprescribing of medicines disproportionately affects vulnerable groups such as people with disabilities.
The review found that problematic polypharmacy, the concurrent use of multiple medicines for one person, is one of the main consequences of overprescribing. People who are taking multiple medicines are more likely to have worse health conditions and as they have been taking medicines for longer, face more difficult decisions about treatment.
For this cohort, it is also harder for clinicians to spot problematic or unnecessary prescriptions, as the cumulative effect can be difficult to evaluate without more specialist training.
Led by Chief Pharmaceutical Officer for England Dr Keith Ridge CBE, the review found 10% of the volume of prescription items dispensed through primary care in England are either inappropriate for that patients’ circumstances and wishes, or could be better served with alternative treatments.
What is overprescribing?
Overprescribing describes a situation where people are given medicines they do not need or want, or where potential harm outweighs the benefit of the medication. It can happen when a better alternative is available but not prescribed, the medicine is appropriate for a condition but not the individual patient, a condition changes and the medicine is no longer appropriate, or the patient no longer needs the medicine but continues to be prescribed it.
Around 6.5% of total hospital admissions are caused by the adverse effects of medicines. The more medicines a person takes, the higher chance there is that one or more of these medicines will have an unwanted or harmful effect.
Dr Keith Ridge said: "Medicines do people a lot of good and the practical measures set out in this report will help clinicians ensure people are getting the right type and amount of medication, which is better for patients and also benefits taxpayers, by preventing unnecessary spending on prescriptions.
"This report recognises the strong track record of the NHS in the evidence-based use of medicines, thanks to the clinical expertise of GPs and pharmacists and their teams, and our achievements to date in addressing overprescribing, which is a global issue."
The key recommendations from the review are:
- the introduction of a new National Clinical Director for Prescribing to lead a 3-year programme including research and training to help enable effective prescribing
- system-wide changes to improve patient records, improve handovers between primary and secondary care, develop a national toolkit and deliver training to help general practices improve the consistency of repeat prescribing processes
- improving the evidence base for safely withdrawing inappropriate medication (deprescribing), and updated clinical guidance to support more patient-centred care. This would include ensuring GPs have the data and medical records they need, and are empowered to challenge and change prescribing made in hospitals
- cultural changes to reduce a reliance on medicines and support shared decision-making between clinicians and patients, including increasing the use of social prescribing, which involves helping patients to improve their health and wellbeing by connecting them to community services which might be run by the council or a local charity
- providing clear information on the NHS website for patients about their medication and the creation of a platform for patients to be able to provide information about the effectiveness and the adverse effects of their medicines; and
- the development of interventions to reduce waste and help deliver NHS’s net zero carbon emissions.
Overprescribing and learning disability
The review concludes that key to stopping overprescribing is ensuring that patients are prescribed the right medicines, at the right time, in the right doses – known as ‘medicines optimisation’.
Overprescribing in people with a learning disability has long been debated and in 2016, STOMP was launched. It stands for stopping over medication of people with a learning disability, autism or both with psychotropic medicines.
It is a national project involving many different organisations such as NHS England, the Medical Royal Colleges and the British Psychological Society, which pledged to work together to stop the over medication of people with a learning disability, autism or both.
Many people with learning disabilities are sometimes inappropriately prescribed medication for behaviours seen as challenging. For many people the medication does not work and can lead to unwanted side-effects such as sedation, weight gain and difficulty moving.
Research by the Learning Disabilities Mortality Review (LeDeR Programme) showed a fifth (19%) of adults with learning disabilities were usually prescribed antipsychotic medication at the time of their death.
In December 2018 NHS England launched STOMP-STAMP STAMP (Supporting Treatment and Appropriate Medication in Paediatrics) which looks at how it can make sure it is supporting children and young people with a learning disability, autism or both better.