Community pharmacists say the following true story is unfortunately all too familiar these days: A High Street pharmacy gets a new prescription from a regular customer who is already using a number of medications prescribed by his GP.
The new prescription applies to Parkinson’s disease. The pharmacist marvels at the man’s misfortune: This patient already takes so many medications for his various symptoms that he was also recently prescribed a medication called Prochlorperazine (brand name Stemetil) just to combat the dizziness and nausea caused by the various medications. Side effects.
And now the patient also has Parkinson’s disease – and has received a new prescription for a medication that can cause serious side effects, including (again) nausea, confusion and an uncontrollable urge to gamble, have sex, or other things to do. It. Obsession with hobbies (the drugs affect the brain’s chemical reward system).
But something in the back of the pharmacist’s mind starts to bother him about prochlorperazine, so he checks the drug’s warning list again.
It shows that the drug can cause Parkinson-like symptoms, such as a shuffling gait, as a side effect in some patients. (The drug can block the effects of the chemical dopamine in the brain, and in Parkinson’s disease itself, the brain gradually loses its ability to produce dopamine, which is essential for movement coordination.)
Commonly prescribed medications can be both harmful and helpful. This is especially true when people take multiple medications that work poorly together or can overload the patient’s body (file image).
So instead of writing that final prescription, the pharmacist called the patient’s doctor.
“The prescriber agreed to evaluate the patient,” the pharmacist told Good Health, “and the patient ended up not receiving Parkinson’s medication.” Instead, his doctor stopped taking prochlorperazine and his Parkinson-like symptoms disappeared.
The pharmacist has asked Good Health to keep his name confidential as he wants to maintain a good relationship with his local prescriber.
But its industry body, the Association of Independent Multiple Pharmacies (AIMP), said the story was typical of a growing national problem: patients are being prescribed an ever-growing list of medications, something called “polypharmacy”.
And while pharmacists themselves can protect against the dangers of polypharmacy, their ability to verify that prescriptions are always appropriate will be severely compromised by the widespread closure of pharmacies — about 540 in 2023 alone — due to rising overhead costs and frozen income. .
The fact is that many prescription medications can be both harmful and helpful. This is especially true when people take multiple medications that work poorly together or can overwhelm the patient’s body.
A 2022 study from the University of Newcastle concluded that each additional medication prescribed to a patient was associated with a 3 percent increased risk of death.
And as a report published in July 2023 by NHS England (NHSE) concluded, it is not uncommon for patients, particularly older people, to take ten or more prescription drugs, which means a 30 per cent increased risk of death on based on that number alone medication. patient takes may not be his or her actual condition.
Polypharmacy is often caused by patients going to hospital doctors or new GPs without being aware of the other medications they are already taking, explains Fin McCaul, director of Prestwich Pharmacy in Manchester and committee member of the High Street Pharmacies bargaining group. , Community Pharmacy England (CPE).
“The problem can also arise if a patient’s GP replaces one of their medications with another, but the old medication is not removed from the prescription list and they end up having to take both medications,” he says.
Dr Leyla Hannbeck, CEO of AIMP, blames cuts to NHS services for the rise in polypharmacy, which means doctors don’t have time to look at patients as individuals, but as a series of illnesses that require medication.
“This leads to additional medication being ‘added’ to control symptoms that arise,” she says. “This is particularly true as patients move from primary care to hospitals and back again – and this results in them receiving increasingly complex medication regimens.”
The government itself admits that at least 10 percent of drug prescriptions are unnecessary. The National Overprescribing Review report published in 2021 said that stopping these unnecessary prescriptions “would be equivalent to a reduction of approximately 110 million items per year.”
According to the Dispensing Doctors’ Association, medicines prescribed in the community will cost the NHS in England £10.4 billion in 2022/2023.
A 10 per cent reduction would save nearly £1.5 billion, not to mention the cost in human misery saved by reducing hospital admissions. A spokesperson for the NHSE told Good Health that efforts are being made to reduce unnecessary prescriptions.
They pointed to this year’s NHSE medicines “optimization strategy”, which recommends that local NHS commissioners consider “tackling problematic polypharmacy” as a new project.
In fact, the NHS has had a policy to reduce polypharmacy for over twenty years. However, there appears to be no change in the number of over-prescriptions, and the Reception Doctors’ Association’s prescribing figures look about the same as they did three years ago.
Why does the problem persist?
Dr Victoria Tzortziou Brown, vice-chair of external affairs at the Royal College of General Practitioners, told Good Health that GPs are highly trained experts in both prescribing and “prescribing”, but are faced with unprecedented demands and dwindling resources.
“GPs are seeing an increasing number of patients with multiple medical conditions who require complex treatment plans, some of which involve careful consideration of interactions between their medications to reduce the potential risk of adverse side effects,” she says.
“It is therefore very important that general practitioners have enough time for consultations with patients.” But general practice is collapsing under the pressure of labor shortages while demand increases.”
Community pharmacists understand the enormous pressure that GPs face. However, they also see other causes of overprescription that pharmacists can address themselves – if they are allowed to.
They say that although community pharmacists are the professionals who physically dispense medicines, see patients the most and are knowledgeable about medicines and their interactions, there is no intention in the current system to “prescribe” medicines while treating a patient. I prescribed them unnecessarily.
Under a scheme introduced by the NHS in 2020, GP practices will instead be paid to carry out structured medicines reviews (SMRs) on patients at risk of polypharmacy.
During this review, which may be performed annually or at varying intervals at the physician’s discretion, a primary care physician or other healthcare professional is expected to review the patient’s medication to discuss whether it is necessary, safe, and appropriately effective.
Although community pharmacists are the professionals who physically dispense medications, see patients the most and are knowledgeable about medications and their interactions, under the current system they are not intended to “prescribe” medications (file image).
But no one seems to know how comprehensive or useful these new SMRs are. Research is currently underway at the University of Oxford into the impact (if any) on the prescribing of medicines since their introduction. The first findings are expected in the second half of 2024.
However, it appears that accessing SMR services from these GP practices can be slow and difficult to say the least, considering NHSE figures from July show that 1.3 million patients a month are waiting four weeks for treatment. See your doctor.
Jay Badenhorst, vice president of the National Pharmacists Association, told Good Health “people have to make do with the limited number of SMR appointments offered by doctors’ offices.”
In countries such as Sweden, the Netherlands, Spain, Canada, Japan and Australia, community pharmacists already have the authority to dispense medicines.
A 2021 review of 24 studies involving more than 4,000 patients in these countries in the British Journal of Clinical Pharmacology concluded that this approach works effectively.
So why not in the UK? In September, two highly respected health organisations, the King’s Fund and the Nuffield Trust, published a report recommending that the NHS pay community pharmacists to carry out medication reviews.
Fin McCaul believes such a system is being held back by the government’s unspoken policy of paying GPs rather than community pharmacists.
“But empowering local pharmacists to review patients’ medications and eliminate unnecessary medications is not only good for the patient, but can also save significant amounts of money by preventing harm and hospitalization.”
Instead, as Jay Badenhorst says: “Cuts in NHS funding mean the number of community pharmacies continues to fall, with hundreds of closures each year.”
More and more patients are now receiving more and more medication.
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Crystal Leahy is an author and health journalist who writes for The Fashion Vibes. With a background in health and wellness, Crystal has a passion for helping people live their best lives through healthy habits and lifestyles.
