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Cover photo of the Royal Pharmaceutical Society

The demand for pharmaceutical help has increased massively. We’ve campaigned for pharmacies, or chemists as our clients like to call them. We worry when pharmacies close. We also worry when we see how much pressure pharmacies are under. Polypharmacy is putting pharmacists under pressure.

In a two-part blog we’re trying to find out why an ageing population is said to be a root cause of increased pharmaceuticals. We examine the contributing factors.

And ask how will pharmacies cope with the pressure?

Pharmacies

Personally speaking, we prefer a holistic approach to life and I’ll hold my hand up as an advocate of natural remedies but medication can be vital and we applaud and support pharmacists and all those who get the right drugs to people at the right time, in the right way.

Advances such as dosette boxes and home deliveries can be life savers.

Pharmacists provide a hugely valuable service to people and community. Their client centered approach is needed and they make time for patients.

Pharmacists are the last point of reference, so responsibility lies with them. They are liable. They check what the GP prescribes and they make sure the right drug gets to the patient with clear instructions.

Unfortunately, pharmacists must adhere to the world’s ‘just in time’ mentality. People don’t like waiting and they put pressure on their pharmacists to deliver drugs. Lots of people shy away from the service element being offered  “why should I tell you, my doctor said so?”

 

Polypharmacy

The term polypharmacy is floating around.  Although the definition of polypharmacy is not clearly defined; polypharmacy refers to the concurrent use of medicines by one patient.  As we age, we live with more health conditions and multi morbidity said to be a symptom of our ageing population.

Polypharmacy can be to combine the effect of a few drugs for better treatment, or to treat the side effects of medication.

Polypharmacy can also arise because of inefficiencies.

 

The ageing population is taking more medication and more professionals are prescribing it to them.

There are many examples. One is, a client may be on drugs from the GP. If that clients goes to hospital, they may be discharged with another set of drugs and another set of instructions.

Records are automated but hospital discharge notes often do not refer to the GP’s instructions clearly.

 

Medication reviews

Medication should be reviewed regularly and always after an episode like a hospital stay.

The day-to-day practise of most commercial pharmacies includes medication reviews with patients.

We’ve found out that the outcomes of those reviews mostly reveal that patients don’t know what their medication is for.

Sometimes the problem is no longer a problem for the patient.  If that’s why they don’t know what the medication is for, it could be a good thing. The situation needs checking by a GP, but once that’s agreed the GP will stop prescribing the medication if it is not needed.

More often, patients carry on ordering medication from doctors and doctors keep prescribing it even when it’s not needed.

 

The reasons for this is at least twofold.

 

Repeat prescriptions and multiple prescriptions

Most surgeries use a repeat prescription ordering system which prevents the patient seeing the doctor.

Often repeat prescriptions are automated and delivered to patients which means even if a patient doesn’t feel like they need the medication anymore, they keep getting it.

It could be because they don’t get an appointment with the GP to stop the prescriptions or they don’t know how to stop the prescriptions coming.

 

Stockpiling

Stockpiling happens because people aren’t taking medication properly but the system keeps providing it as if they were.

Either they never took it in the first place because the GP didn’t take the time to explain or convince the patient, they forgot, or they didn’t like the side effects of the medication and they stop taking it.

Deliberate stockpiling or ‘saving it’ comes from a fear that it may be difficult to get the medication in the future.

 

Returning medication

There was a time when medication was routinely put down the loo!

Fortunately, people know to return drugs to pharmacists. It’s often left until a patient passes away before unused medication is found and disposed of.

 

Pharmacists tell me that it’s very common for family to hand in carrier bags full of medication to pharmacists.

Recently a patient’s family returned 10 boxes of unused dalteparin which costs £42.34 a box. Totalling £423.40.

Unused medication has to be destroyed.

 

This is a failure for healthcare providers as well as the patient’s fault.

 

Patient focussed

Pharmacists are professionals and they are highly skilled.

Because they are commercial, and patients have a choice where to fulfil their prescriptions, pharmacists are client focussed.

Benefits like pharmacists being open when the GP is closed, taking the time to explain medication, providing medication in dosette boxes and home-delivering medication are some of the many ways pharmacists help patients.  And in turn pharmacists help reduce waste.

Sadly austerity measures look set to keep patients away from their doctors, and whenever the delivery of medication is ‘systemised’, polypharmacy will increase.

 

Polypharmacy is worrying  because it’s wasteful, it’s bad for health and it’s putting pressure on pharmacists.

 

Automation and less time

Pharmacists are fulfilling prescriptions at a scale we’ve never seen before and they are looking at ways to deal with the scale of their workload.

What we really want is less medication and healthier, happier people. Pharmacists need have more time to spend with clients to find out what they are doing with their medication and help them take the right steps if they no longer want it.

We do not provide medical advice in our service.  We notice, we prompt, we make sure our clients seek advice from professionals and we accompany them if needed to ensure the advice is remembered, passed on and adhered to.  We don’t stand by when age in itself is blamed for anything. An ageing population is not to blame for polypharmacy. The failures are systemic and can be put right.