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Stopping ‘risky’ medicines for older people

15/09/20

A £2.4 million initiative to stop the use of potentially harmful medicines prescribed to older patients will be trialled across hospitals in England, following research led by UEA.

Half of older people admitted to hospital arrive having been prescribed a medicine that over time has more risks than benefits, which can lead to experiencing side effects. 

But previous research from UEA has shown that less than one in 10 patients has one of these medicines stopped whilst in hospital. 

Now, researchers at UEA will lead a trial to solve this problem, thanks to funding from the National Institute for Health Research.

It comes as new research published today reveals a new approach to increasing the likelihood of potentially-harmful medicines being deprescribed while patients are in hospital.

Dr Sion Scott, from UEA’s School of Pharmacy, led the study. He said: “We know that a large number of older people arrive in hospital, having been prescribed a medicine that over time has become inappropriate for them. 

“These medicines offer little or no benefit to the patient but their side effects cause problems, like making them feel drowsy, nauseous or have trouble getting to sleep. These problems impact a person’s quality of life to the extent that they can cause re-hospitalisation.” 

Previous research from the team showed a number of barriers stopping hospital doctors and pharmacists from de-prescribing. These include thinking that patients and carers may be too attached to their medication, a perception that stopping medication is riskier than continuing to take it, and de-prescribing being a low priority in hospitals.

The research team worked with senior geriatricians and pharmacists from five hospitals in England to develop a better approach to deprescribing which includes sharing best practice and training pharmacists to help change their beliefs about the risks of de-prescribing. 

The new approach also includes interventions ranging from implementing an organisational action plan to prioritise deprescribing, to restructuring pharmacists’ working patterns to enable their contribution to deprescribing decisions.

Dr Scott said: “We have put together an approach for hospitals to promote things that boost confidence and remove the hindrances to stopping risky medicines. This includes the need to highlight good role models for prescribers and for hospitals to make deprescribing risky medicines a priority.

“The next step is to trial the new approach across hospitals in England.”

The team will roll out the £2.4 million trial across 42 hospitals, in collaboration with researchers at the Universities of York, Newcastle and Leeds, the Norfolk and Norwich University Hospital and Addenbrooke’s Hospital in Cambridge.

Prof Debi Bhattacharya from UEA’s School of Pharmacy will be leading the trial. She said: “Continuing medicines when they are not needed unnecessarily harms patients and wastes NHS money. The government recognises this as a major problem through its National Overprescribing Review. We are delighted that our approach to addressing this problem has been funded to undertake a national trial to change hospital practices.”  

‘A practitioner behaviour change intervention for deprescribing in the hospital setting’ is published in the journal Age and Ageing on September 2, 2020. 

The research was funded by Pharmacy Research UK and Norfolk and Norwich University Hospitals NHS Foundation Trust, and supported by the Medicines Optimisation Research Group East Anglia (MOG_EA), which is a part of UEA Health and Social Care Partners (UEAHSCP).