The National Institute for Health and Care Excellence has published new draft guidance on medicines optimisation to ensure people get the best possible outcomes from the medicines they are prescribed.
As the population ages and life expectancy increases, more people are taking greater numbers of medicines than ever before, so getting the most out of them is important to patients and potentially reduces costs for the NHS, says NICE, which is consulting on its proposals.
The draft guidance emphasises that people should be at the centre of decisions about their care, and that shared decision-making should be based on the best available evidence, taking account of the patient’s individual needs, preferences and values.
15 million live with long-term condition
Looking at the scope of the challenge, NICE notes that around 15 million people in England are now living with a long-term condition (LTC) such as heart failure, that cannot at present be cured but can be controlled by medicines and other treatments. Also, the number of people living with several LTCs being managed with a number of medicines (polypharmacy) is expected to rise from 1.9 million in 2008 to nearly three million by 2018.
30%-50% of medicines prescribed for LTCs are thought not to be taken as intended, and the risk of patients suffering harm from their medicines increases with polypharmacy; around 5%-8% of all hospital admissions are due to preventable problems with medicines such as adverse effects or their interaction with other medicines or conditions. Safety is therefore another important consideration when optimising medicines and can be a continual challenge, says NICE.
When patients transfer between different care providers, such as at the time of hospital admission or discharge, there is a greater risk of poor communication and unintended changes to medicines; in these situations, 30%-70% of patients experience an error or unintentional change to their medicines.
Poor communication can lead to sub-optimal use of medicines and may affect outcomes, so medicines information when a person transfers from one care setting to another needs to be comprehensive. It should include: known allergies and reactions to medicines or their ingredients, and the type of reaction experienced; what medicines the person is currently taking and why; and changes to medicines, including those started or stopped or dosages changes, and reasons for the change.
The draft also makes recommendations about what systems for identifying, reporting and learning from medicines-related patient safety incidents are effective and cost-effective. This includes ensuring that patients or their family members or carers understand how to identify and report any medicines-related patient safety incidence.
The importance of conducting medication reviews for certain patient groups, the use of self-management plans and patient decision aids in consultations involving medicines use, to improve patient outcomes, are also covered in the draft guideline, which is open for consultation until November 7.
UPDATE: Commenting on the news, the Association of the British Pharmaceutical Industry’s chief executive Stephen Whitehead said: “I am particularly pleased that the draft guidance has recognised that patients should be at the centre of decisions about their care, and that shared decision-making should be based on the best available evidence, taking account of the patient’s individual needs, preferences and values”.
He claimed that the ABPI “has always maintained that supporting patients to use medicine more appropriately will not only deliver better patient care, it will also provide cost savings…by improving NHS productivity – by reducing the need for longer term, more expensive treatment and helping to shift care from hospitals into the community”.
