Polypharmacy: seeing it through patients' eyes

How do patients experience having to take multiple medications? What are the implications for policy and practice? These are slides framing a presentation at a joint Royal Pharmaceutical Society/Royal College of GPs conference on polypharmacy on 20 April 2016.

1. Polypharmacy: seeing it through patients’ eyes Jeremy Taylor, CEO, National Voices At The Challenge of Polypharmacy 20 April 2016

2. Coalition of 160+ charities Founded 2008 Championing person centred care, a strong patient and citizen voice, and services built around people Standing up for voluntary organisations and their vital work for people’s health and care

3. A word on words Morbidity Co-morbidities Multi-morbidities Polypharmacy Discharge

4. Person centred care: See the person , not the illness Care for me (or my loved one), expertly, safely, compassionately Join up your services around me (or my loved one) But don’t take over – I need choices, control, independence; to be involved; to get on with my life

5. Medicines: what matters to patients? What is the matter with me? What will happen? What does this treatment do? Are there side effects? What’s the choice? What’s the best treatment for me? Can I cope with taking it? What about when I’m going into hospital? What about when I’m coming out of hospital? Is it working?

6. Jack’s story Jack is 65 and lives with a number of conditions: Asthma Osteoarthritis Diabetes Carpal tunnel syndrome Underactive thyroid Cancer survivor (with colostomy) Enlarged prostate And more besides

7. What keeps Jack going Positivity: a proactive self-manager (but has been depressed in the past) Short term goals: eg nights out with friends L ong term goals: studying; travel

8. What gets Jack down “ It’s the arthritis, the carpal tunnel and the bladder control…they’re the things that really affect my quality of life ” “I’ve got four pages of repeat prescriptions, of about seventeen different items, the trouble is they all get out of sync…so I’m in and out of the GPs ordering repeat prescriptions and picking stuff up from the pharmacy virtually every week.” “I had 13 appointments last month. Just as well I’m retired!”

9. What Jack would like More coordination, including: One person he can go to for help and advice who has an overview of all his conditions

10. What do other people say? a “burden of work” (Salisbury et al) Understanding Adhering Uncoordinated prescription, review of meds Multiple single pathway driven appts & interventions adverse impact on mental health/quality of life side effects/harms/interactions of medications themselves And an issue of equity (multiple conditions & deprivation)

11. The burden of work…. “Research shows that for people taking many medications, the effort and attention that goes into understanding and remembering what each is for, getting repeat prescriptions in a timely way (on different schedules), knowing when to take what, and adhering to the various regimes can become the dominant task in self-management (potentially at the expense of focusing on other areas eg diet, exercise, social activity )” Don Redding, director of policy, National Voices 2016

12. Person centred coordinated care “ I can plan my care with people who work together to understand me and my carer (s), give me control, and bring together services to achieve the outcomes important to me .” I have the Information I need… I am supported to achieve my goals…. The professionals work as a team. I always know who is coordinating my care I’m involved as I want to be in decisions… I work with my team to agree a care and support plan… When I move between settings there is a plan in place….

13. Tackling the challenge of polypharmacy Why am I on all these medicines? Share medicines decisions around my needs, goals and preferences Plan holistically for my care and support (not pathway by pathway) Support me to self-manage Join up! R eview my medicines regularly and holistically (not treatment by treatment) Doctors and pharmacists (and other professionals), please work together!

14. "The starting point for any system of care should be to ask what it takes to lead a good life". The Generation Strain: Collective solutions to care in an ageing society. McNeil & Hunter IPPR April 2014

15. Thanks for listening! Questions? @ NVTweeting @ JeremyTaylorNV www.nationalvoices.org.uk