National Institute for Health and Clinical Excellence (NICE)
People should be more involved in decisions about the medicines they take to ensure they get the best outcomes from them, says NICE in new guidance
A new guideline from NICE on medicines optimisation published yesterday outlines how putting people at the centre of decisions about their care can enable them to use the medicines they are prescribed safely and effectively and get the best possible outcomes from them.
The guideline says that people should be at the centre of decisions about their care. Shared decision-making (across health and social care where relevant) should be based on the best available evidence and take account of the patient’s individual needs, preferences and values.
Around 15 million people in England now have at least 1 long-term conditioni, such as heart failure or diabetes, that cannot at present be cured but can be controlled by medicines and other therapies. However, figures suggest that as many as half of medicines prescribed for people with these conditions are not taken as intendedii.
It is estimated that the number of people living with several long-term conditions (multimorbidity) being managed with a number of medicines (polypharmacy) will rise from 1.9 million in 2008 to nearly 3 million by 2018i.
“As the population ages and life expectancy increases, more people are taking more medicines than ever before” said Paul Chrisp, Programme Director for the Medicines and Prescribing Centre at NICE. “Getting the most from them is important to patients and potentially reduces cost for the NHS. However, medicines use can be complex. Enabling patients to take their medicines safely and effectively has been a longstanding challenge for the health service. The NICE guideline on medicines optimisation sets out what needs to be done by all health and social care practitioners and organisations to put in place the person-centred systems and processes required for the optimal use of medicines. The guideline also supports the safe and effective management of long-term conditions and when people are taking a number of medicines to treat more than one condition.”
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. When patients move from one care setting to another, between 30% and 70% of patients have an error or unintentional change to their medicinesiii.
The guideline recommends that health and social care practitioners should share relevant information about the person and their medicines when a person transfers from one care setting to another. This should include details of the medicines the person is currently taking, information about allergies the person has and any changes to a person’s prescriptions including treatments started or stopped, or dosage changes, and reasons for the change. Ideally, this information should be shared within 24 hours of a person’s transfer from one care setting to another.
The importance of carrying out medication reviewsiv for some people, such as those taking multiple medicines (polypharmacy), people with chronic or long-term conditions or older people, is also addressed in the guideline. These are important in enabling health and social care practitioners to reach an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medicines-related problems and reducing waste.
The guideline recommends that these reviews should take into account the person’s (or their carers’) views and understanding about their medicines, whether they have any concerns, questions or problems with their medicines, as well as how safe they are, how well they work, how appropriate they are and whether their use is in line with national guidance and, importantly, whether they are likely to provide overall benefit.
The safety of medicines is another important consideration when optimising medicines and the guideline recognises the importance of health professionals having an up-to-date list of all the medicines a person is taking (medicines reconciliation), particularly when they go into hospital, move from one ward to another or to a different hospital, and when they are discharged from hospital.
When a person is transferred from one place of care to another, the guideline recommends that checking and listing their medicines should be done within 24 hours of their transfer. When they are discharged from hospital or another place of care, medicines reconciliation should be carried out no more than 1 week after their practice receives notification of their discharge, and before a prescription or new supply of medicines is issued.
The guideline also makes recommendations about what systems for identifying, reporting and learning from medicines-related patient safety incidents should be in place. This includes ensuring patients or their family members or carers understand how to identify and report any medicines‑related patient safety incidents.
The use of structured, documented plans for people with chronic or long-term conditions to help them manage their condition using medicines, and patient decision aids in consultations involving medicines use to improve patient outcomes are also covered in the guideline.
Dr Weeliat Chong, Chief Pharmacist of Humber NHS Foundation Trust and Chair of NICE Medicines Optimisation Committee said: “Over the past 10 years there have been many strategies, models and concepts for optimising a person's medicines. Medicines optimisation is not a new concept. This guideline makes a series of recommendations based on a review of all the relevant clinical and health economic evidence of what works. Involving people in decisions about their medicines to enable them to get the best possible outcomes is a key component of the guideline.
“The scope of medicines optimisation is vast, so the 48 recommendations in the guideline focus on areas that are most likely to deliver positive changes in today's NHS. These include systems for identifying, reporting and learning from patient-safety incidents, the use of patient decision aids, self-management plans, patient-centred organisational and cross sector working, communication at care interfaces, medicines reconciliation, medication review, and clinical decision support.”
Liz Butterfield, Royal Pharmaceutical Society England Pharmacy Board lead for Medicines Optimisation, said: “We welcome this guideline that asks pharmacists, doctors and nurses to discuss and pay attention to people’s wishes about treatment. The RPS principles of medicines optimisation are reflected in this guideline and emphasise that decisions about treatment must be shared between patients and healthcare professionals.
“Pharmacists are increasingly providing valuable cost and clinically effective care through services such as the NHS New Medicines Service. The unacceptable level of medicines waste, estimated at £300 million per yearv, means all health practitioners need to think differently about how medicines are used in the NHS. For people living with long term conditions a focus on best use of medicines throughout their lifetime, not just when diagnosed, will mean better care and health outcomes.”
Alison Clough, Executive Director - Commercial, ABPI, said: “Medicines play a crucial role in the health of our nation, but we know that patients aren’t always getting the most from their medicines. We welcome the publication of this guidance from NICE and look forward to working with NHS England to implement the guidance and promote medicines optimisation across all four principles, as outlined by the Royal Pharmaceutical Societyvi, to ensure that the right patients are able to access the right medicines at the right time.
“To help play its part, the ABPI is collaborating with NHS England on a joint programme of work, guided by the principles of medicines optimisation. The programme will help NHS medical, pharmacy, operations and finance staff understand and harness the unique opportunity of the Pharmaceutical Price Regulation Scheme (PPRS) - where the pharmaceutical industry has agreed to underwrite the growth in branded medicines spend, to agreed levels, with agreed exclusions- ensuring that patients can get the right choice of medicine with industry underwriting spending growth.”
For further information, please contact the NICE press office on 0300 323 0142 /firstname.lastname@example.org or out of hours on 07775 583 813.
Notes to Editors
References and explanation of terms
i Department of Health: https://www.gov.uk/government/publications/long-term-conditions-compendium-of-information-third-edition
ii World Health Organisation 2003
iii Royal Pharmaceutical Society: http://www.rpharms.com/previous-projects/getting-the-medicines-right.asp
iv structured, critical examination of a patient's medicines with the objective of reaching an agreement with the patient about treatment, optimising the impact of medicines, minimising the number of medication-related problems and reducing waste’ (National Prescribing Centre 2008).
v University of York Economics consortium/The School of Pharmacy, University of London: http://www.york.ac.uk/news-and-events/news/2010/research/nhs-medicines-waste/
About the guidance
- The guideline on medicines optimisation will be available on the NICE website from 00:01 on Wednesday, 4 March.
- A version for people, their family members or carers is also available on theNICE website
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
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