What problem are we trying to tackle?
Medication reviews are not patient centred and do not involve shared decision-making, with a focus on single conditions and medicines management rather than the patient. Guidelines also focus on single long-term conditions and do not account for multi-morbidities, frailty, non-drug treatments and deprescribing. As a system, there is not routine, consistent identification and prioritisation of people who would benefit most from a Structured Medication Review.
The principles of medicines optimisation and deprescribing through the use of Structured Medication Reviews are not currently reflected in the education, training and professional development of all healthcare professionals.
Our aims in south east London:
- For patients to be prescribed medicines appropriately through a shared decision-making process (NOR report R8)
- For the healthcare workforce to be trained to understand the causes and consequences of overprescribing and how it can be remedied through Structured Medication Reviews, shared decision making and the ability to access specialist support (NOR report R16, R17 and R18)
- For treatment guidelines in SEL to incorporate recommendations for reviewing and deprescribing medicines in the context of shared-decision making, so that it becomes part of routine care (NOR report R3 and R5)
The work that we are doing:
- Specialist support for Structured Medication Reviews in complex patients
- Reducing overprescribing in care homes – pharmacy technician led interventions
- Specialist support for Structured Medication Reviews in Learning Disability and Autism patients
- Patient reported measure of Shared Decision Making during Structured Medication Reviews
- Overprescribing training and resources
Pilots described are based on preliminary results and will be updated once a full evaluation has been concluded.
