Medicines management


Updated April 2008

As people get older, their use of medicines tends to increase. Taking into consideration how the ageing process affects the body’s capacity to handle medicines becomes increasingly challenging when attempting to ensure that medicines are prescribed and used effectively. Multiple diseases or complicated medication regimes may affect a patient's capacity to manage their own medication. This may cause confusion, and is often related to such factors as adverse drug reactions, missed medication or repetition of prescription. Self medication, or medication by relatives or friends/carers, is common practice and administering prescription drugs to the older person by non-medically qualified persons is a serious hazard. Non steroidal anti inflammatory drugs (NSAIDs) such as painkillers are often taken for rheumatoid disease by the older person, who can later become reliant on them. This dependence on the drug for mobility can be a result of poor medicines management which can seriously affect the health of the individual. These drugs are extremely toxic to kidneys, especially those of the older person.

Medicines management is a term that has been used to describe methods to overcome these problems and encompasses the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care. The components of medicines management should be:
  • optimising a medication regime (right drug at the right time)
  • facilitating adherence to medication, including beliefs and fears as well as physical problems
  • organising supply and administration support, such as repeat dispensing systems
  • provide monitoring and feedback systems.[see reference 1]
As one of the primary health professions in the NHS, pharmacy has a vital role in delivering healthcare to the individual. A key theme of the NHS Plan is empowering patients to take an active role in managing their own pharmaceutical care. This concept is discussed further in the 2006 BMA Patient Liaison Group discussion paper 'The Expert Patients Programme' which can be accessed here. Patients are not merely passive recipients of prescribing decisions. The older person is especially important in this respect as 80 per cent of over 75s take one or more medicines and 36 per cent of over 75s take 4 or more.[see reference 2] Those aged 60 and over receive more prescription items per head than any other group. In England in 2005, the average was 14.3 prescription items per head of population with 3.8 items on average to children under 16, 9.1 for persons aged 16-59 and 38.4 items to those 60 years and over.[see reference 3]

Effective medicines management is essential for independent living for most older people. It is recognised as no longer effective or appropriate to merely provide the older person with a ‘Dosett Box’ (a pill box with times/days marked on it, which helps people take their medications at the correct time). In order to provide effective treatment it is important that patients adhere to the doctors’ instructions and take the medicines prescribed, and that the need for the medication is reviewed at appropriate intervals, however:
  • up to 20 per cent of prescriptions are not ‘cashed’
  • around 50 per cent of people do not take their medicines as intended
  • 80 per cent of drugs prescribed are repeat prescriptions without consultations.[see reference 2]
Medication review is usually conducted by the GP with the patient. 'Medicines and older people', the NHS document dealing specifically with implementing medicine's related aspects of the National Standards Framework, recognises that pharmacists and nurses play a part in medicines advice. Evidence from the US shows that pharmacists could improve patient care by reviewing drug treatment and a study in Britain found that consultations with a clinical pharmacist were an effective method of reviewing the drug treatment of older patients.[reference 4]

The 2007 BMA Board of Science report Evidence based prescribing provides an information resource for healthcare professionals on evidence-based prescribing. It explores the factors that may affect prescribing practice, how effective prescribing can be achieved, and the problems resulting from inappropriate prescribing. Further information on pharmacovigilance and the reporting of adverse drug reactions can be found in the 2006 BMA Board of Science report Reporting adverse drug reactions: a guide for healthcare professionals.

References:
  1. Managing medicines (2002). History and development. London: Managing medicines - A Resource Centre for Medicines Management and Pharmaceutical Care.
  2. Rayer T (2002) Medicines Management – Independent living for older people [paper for conference]. London: University of Leeds.
  3. NHS Information Centre (2006) Prescriptions dispensed in the community statistics for 1995 to 2005: England. London: Information Centre, Government Statistical Service.
  4. Zermansky AG & Petty DR et al (2001) Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. British Medical Journal 323:1340-1344.
Further information:

© British Medical Association 2008

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