Safer prescribing for frailty: polypharmacy reduction in general practice

Older people living with frailty often take many medications (polypharmacy) and are at higher risk of adverse drug events and hospitalisation. Individualised medication reviews are therefore important.

This project run by Harrogate and Rural District Clinical Commissioning Group explored how the STOPP tool (Screening Tool of Older Persons’ potentially inappropriate Prescriptions), in conjunction with other evidence-based approaches, could best be used to improve medication reviews with frail populations.

Twelve primary care teams recruited from across North and West Yorkshire took part in the initiative. A training and action for behaviour change approach to improvement was used, which included: training in clinician behaviour change theory and tools; training in change management and quality improvement techniques; increasing awareness of evidence-based tools available to support medication reviews, such as the STOPP tool and the Scottish polypharmacy guideline; and maximising opportunities to learn and share good practice with fellow primary care practitioners.

The project achieved a 6% reduction in the average number of prescription items prescribed to people with frailty. An audit of the records at one of the GP practice teams showed that all the medicines stopped were for identifiable clinical reasons and displayed a reduction in inappropriate polypharmacy.

Practitioners said they felt more confident to de-prescribe and that the project had affected the culture of prescribing within their practices.

Involving patients in the project was valuable, with their contributions providing both context and motivation.

The project has been showcased widely and other areas are interested in adopting the methods. The team is developing a change package to support the spread of learning from the initiative.

Contact details

For more information about this project, please contact:

• Christopher Ranson, Senior Pharmacist, Harrogate and Rural Districts Clinical Commissioning Group
• Sarah De Biase, Programme Manager Healthy Ageing, Academic Unit Elderly Care & Rehabilitation, Bradford Teaching Hospital NHS Foundation Trust, Connected Yorkshire, part of Connected Health Cities
• Tony Jamieson, Programme Lead, Yorkshire & Humber Academic Health Science Network, Improvement Academy
• Megan Humphreys, Implementation Manager, Healthy Ageing Collaborative