Improving Medicines use in People with Polypharmacy in Primary Care

Prescribing medicines is one of the most important things doctors do to treat illness and improve peoples’ health. The UK population is steadily ageing and people often have more than one health problem. This means more people are taking multiple medicines, which is called polypharmacy. Polypharmacy is common. It is often necessary to help a person keep well, but polypharmacy can also cause problems such as side effects or confusion about exactly what medicines are to be taken when. We need to find ways of improving the use of medicines in people with polypharmacy so we can reduce some of these problems. However, there is no good scientific evidence to help health care professionals decide how to most effectively do this. The aim of this project is to create an effective approach for improving the use of medicines in people with polypharmacy attending general practice.

We are developing a new approach (called IMPPP) to improve how we manage polypharmacy. IMPPP has several parts to it. It will improve how GP surgeries organise reviews of medicines for patients. It will encourage better care by providing GPs with training, payments, and information about how well their practice is performing. It will use a new computer program to help GPs and pharmacists make the right decisions about medicines. Patients’ concerns and wishes about their medicines will remain central.

We will base IMPPP on similar approaches our team has used in Scottish GP surgeries, called POEMS and DQIP2. Unfortunately, POEMS and DQIP2 are both developmental, so we cannot tell if they will be successful in improving care. In developing IMPPP, we will be able to use and improve upon what we have learned from POEMS and DQIP2.

Our project has 3 parts:

1. Firstly, we will speak to health care professionals and patients with experience of POEMS and DQIP2. This will tell us what they think of these existing approaches. We will use prescribing data gathered by the Scottish GP computer systems to help us understand which people with polypharmacy will benefit most from improved care. We will use this information to design the new IMPPP method, with the help of patients and other experts.

2. Secondly, we will test IMPPP in 3 Bristol-based GP surgeries. We will interview individuals in these surgeries to find out about any problems with IMPPP so we can improve it.

3. Thirdly, we will carry out a clinical trial in Bristol and Staffordshire. The trial will compare 27 surgeries using IMPPP to 27 surgeries using current, normal practice. We will check whether IMPPP results in improved medicines safety, less use of health services, and better quality of life and less burden of treatment for the patients involved. We will also check whether IMPPP is acceptable to patients and both doctors and pharmacists, and will find out the cost implications of IMPPP for the NHS.

This research will provide us with valuable information about which people with polypharmacy might benefit most from having improvements made to their medicines, and tell us what approaches work best for improving the use of medicines in people with polypharmacy. If it works, it should be possible to use the IMPPP approach across the NHS, helping many people with polypharmacy. We will work closely with the public and other patient groups throughout this research, to make sure that we take on their views in the design of the IMPPP approach itself, the research more generally, and when publicising the findings.

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