Transcript Document
Optimising Safe and Appropriate Medicines Use Katie Smith Director East Anglia Medicines Information Service July 2013 Thought for the day… “it is an art of no little importance to administer medicines properly: but, it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them”. Philippe Pinel, psychiatrist (1745-1826) Background • • Sept 2010 – East of England Medicines Efficiency Programme meeting Need practical evidence based guidelines to be able to stop medicines, 1 of 21 priorities listed in work programme – Focus on end of life? – Prescriber support? – Large amount of time spent looking for information • Statins, bisphosphonates, dipyridamole • Build on work done by Val Shaw in Cambs Literature search • • • • Very little info on how to actually stop Tools to review PIMs/PIDs/PIP Beers, IPET, STOPP-START Archives of Internal Medicine – Less is more • 2011 search vs. 2013 search • Same classes of PIMs world wide! • NICE do not do list Useful literature • • • • • • • • Naughler CT et al. Development and validation of an improving prescribing in the elderly tool (IPET). Can J Clin Pharmacol 2000; 7: 103-7 Gallagher P et al. STOPP and START. Consensus validation. Int J Clin Pharmacol Ther 2008; 46 (2): 72-83 American Geriatrics Society Updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Ger Soc 2012; 60: 61631 Schiff GD et al. Principles of conservative prescribing. Arch Intern Med 2011; 171 (16): 1433-40 Scott IA et al. Minimising inappropriate medications in older populations: a 10-step conceptual framework. Am J Med 2012; 125 (6): 529-37 Garfinkel D. Feasibility Study of a Systematic Approach for Discontinuation of Multiple Medications in Older Adults- Addressing Polypharmacy. Arch Intern Med 2010;170 (18):1648-1654 Baqir W et al. Reducing the ‘pill burden’ – complex multidisciplinary medication reviews. Int J Pharm Prac 2012; 20 (suppl 2) p31-101 Straand J et al. Stopping long-term drug therapy in general practice. How well do physicians and patients agree? Fam Practice 2001; 18 (6): 597-601 Other sources • • • • • BNF CKS DTB NPC Dr Viveca Kirthisingha, Consultant Community Geriatrician, Cambridgeshire Community Services • Colleagues – thanks to Denise Farmer, Val Shaw, David Erskine, Dr Julian Brown, Paula Wilkinson OSAMU document • • • • • • • • Short – but enough detail/practical info to be useful All statements referenced & reference list included BNF order Groups of medicines rather than each individually Covering statement Clinical and cost risk Accompanying PIL Briefing (new for 2013) Availability, promotion.. • Draft document shared – not everyone positive • PJ - NHS Highland/Lothian polypharmacy guidance http://www.central.knowledge.scot.nhs.uk/upload/Pol ypharmacy%20full%20guidance%20v2.pdf • PrescQIPP website • Shared across EoE • Poster at the November 2012 Pharmacy Management National Forum in London based on work Val did with care homes in East Anglia Results from OSAMU use • 8 care homes in Norfolk & Cambs • During 235 medication reviews, 398 medicines safely and appropriately stopped • Mainly antihypertensives, bisphosphonates, laxatives, PPIs, statins • Not antipsychotics for dementia & antidementia medicines • Multidisciplinary education tool Care Med Trial protocol Care Med is a 3 year RCT being undertaken in Cambridgeshire and Norfolk with a RfPB grant. The trial protocol is available at: Desborough et al. Trials 2011, 12:218 http://www.trialsjournal.com/content/12/1/218 Deprescribing? • Think about how to withdraw when the drug is first prescribed. • Process of stopping is not taught or researched. • Not considered as a high priority for clinical research funding? • Vast majority of ADRs occur during long term use. What next? • Seek feedback from users • Encourage use across whole region, not just the East • Other SHAs/QIPP workstreams have shown interest in the document • Community pharmacists / Hospital pharmacists • More research on its use and impact on patient care / reduction in waste / savings / costs avoided Where to find OSAMU http://www.prescqipp.info/?Itemid=209 Click on the green text, then the red download box Further questions after today? Please email – [email protected] [email protected] Thank you for listening Any questions?