Harry McQuillan: If you want to cut unnecessary medicines, involve the pharmacists

More and more older patients are leaving pharmacies with sackfuls of medication prescribed by doctors, which may no longer be appropriate for their conditions and do not deliver a benefit
More and more older patients are leaving pharmacies with sackfuls of medication prescribed by doctors, which may no longer be appropriate for their conditions and do not deliver a benefit
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In recent years, it has become more common to see people leaving their pharmacy with carriers full of medication as opposed to the small paper bags of yore. Up and down the country, pharmacy teams and patients alike have running jokes about this very matter: “I could open my own pharmacy at home!” or “If I jumped up and down you’d hear me rattle!”

But all joking aside, why is it that people today seem to be taking so much more medication?

Harry McQuillan is chief executive of Community Pharmacy Scotland.

Harry McQuillan is chief executive of Community Pharmacy Scotland.

The answer is fairly complex, but put simply it comes down to a combination of an ageing population and advances in treatments. With a better understanding of diseases thanks to scientific progress, more effective drugs and vaccines can be developed and we are able to give better lifestyle advice.

This leads to people living much longer, healthier lives – something which can only be celebrated. However, as people get older, they are more likely to develop further ­conditions associated with advancing years. Over the course of a longer life, this generally means an accumulation of health problems and medications to treat or prevent these problems.

The term Polypharmacy is used to describe where a person takes five or more regular medications for different conditions. It’s important to note that in most cases, this is entirely appropriate and necessary for the person to live their life to the fullest. Where the Scottish Government and the NHS would like to focus their efforts is on inappropriate Polypharmacy.

This is where the combination of medications that is taken does not deliver the desired health outcomes, or no longer matches what really matters to that person with respect to their wellbeing. This may be due to side effects, interactions or a change in the person’s disease state, organ function or personal goals.

As well as the considerable waste associated with medications which people do not need or want, there is undoubtedly unintended harm caused where inappropriate Polypharmacy is not identified and resolved, and this is what drives ­policies aimed at addressing the issue.

As such, many pharmacists (as the experts in medicines) are using their unique skills to look at Polypharmacy across Scotland with a view to optimising patient medication, but this is mostly restricted to specific NHS clinics and those with prescribing qualifications.

We at Community Pharmacy Scotland believe that much more can be done and that tapping into the network of 1256 community pharmacy teams is the best way to make a significant impact on the health of a vast number of Scottish citizens who would benefit from a review.

Currently, the pharmacists in our network work in partnership with patients on a daily basis to reduce inappropriate Polypharmacy. ­However, this is not a formalised or specifically targeted service and any interventions are recorded on systems which only the pharmacy will have access to. By having a proactive service in place, our members could make an even more significant and measurable contribution to this ­priority policy matter, and ensure that the medications that the people of Scotland are taking are only those which deliver benefit to them. Several things would need to happen for our ambition to be realised. First and foremost, Polypharmacy would need to be included as a distinct part of our national contract, along with fair and appropriate remuneration.

In practical terms, this could not happen until community pharmacists are granted access to relevant parts of the patient record, and the ability to add to these records when interventions such as Polypharmacy reviews are carried out.

This needs to happen so that all healthcare professionals involved in working with patients to get the best out of their medicines can see the whole picture and collaborate to effect changes that improve health and wellbeing. We have the skills, all we need is the framework and the tools to move forward.

Harry McQuillan is chief executive of Community Pharmacy Scotland.