Improving patient care and reducing costs with a polypharmacy review

Background

Birmingham South Central Clinical Commissioning Group commissioned our pharmacist-led Polypharmacy Review Service to carry out a three-year polypharmacy review starting October 2016. This continued after the CCG merged with Birmingham CrossCity and Solihull CCGs to form Birmingham and Solihull CCG in April 2018.

Action

Level 3 medication reviews for adult patients are delivered by a team of pharmacists with support from technicians and an administrator. EMIS searches in practices are risk-stratified to prioritise patients for review. An adapted version of the RIO tool is used to identify patients at risk of hospital admission.

Face-to-face reviews are carried out in the clinic or in the patient’s own home. Pharmacists then meet GPs to explain their recommendations and follow up patients as necessary. The reviews:

• ensure each patient is prescribed safe and appropriate medicines
• assess any adverse drug reactions and drug interactions
• assess patient compliance and address any issues
• de-prescribe unnecessary or harmful medicines
• provide information and address patient concerns
• monitor drug therapy
• resolve interface issues, for example with secondary care
• produce a patient-specific pharmaceutical care plan.

Impact

The Polypharmacy Review Service is reducing avoidable harm and potential risk of premature death, enhancing quality of life for people with long-term conditions, helping people recover from illness or injury, and improving patients’ experience of care.

By November 2018 (with just under 12 months to go), a total of 4,225 drugs had been stopped, 2610 quantity reduced and 150 switched, and 307 potential hospital admissions had been avoided. From the 5,343 patients reviewed, the total estimated cost improvement resulting from de-prescribing, switching drugs and reducing quantities and from potentially reduced hospital admissions is just over £1million.

The review team are continuously undertaking evaluation surveys with GPs and patients. Of the 1026 patient survey returns received so far, 99% of respondents found their reviews very helpful or helpful. Of the 61 GP practice returns, 98% of respondents found the reviews and the scheme very helpful or helpful.

I can’t emphasise enough how valuable the polypharmacy service was, I wish it was available annually. It is extremely useful.”
Dr Iram Khattak | The Khattak Memorial Surgery, Birmingham

“Hopefully this service will continue as it has been very useful for us & the patients.”
GP responding to survey

“Good service. Should be recommended to all patients.”
Patient responding to survey