REVIEW
Deprescribing and the barriers
Pharmacists are well placed members of the multidisciplinary team to advise and initiate
deprescribing but there is still paucity of evidence around deprescribing and the long-term
benefits are yet to be defined
Kiran Channa
MPharmS MFRPSI
Worcestershire Acute
Hospitals NHS Trust, UK
Nazish Khan
DPharm MPharm
MPharmS FFRPS
The Royal Wolverhampton
NHS Trust, UK
An increasingly ageing population presents
with complex health and social care needs.
Often patients are frail and multimorbid and require
a host of different medications to manage their
comorbidities. Polypharmacy results from
inadequate medication reviews, such that
medications that are no longer required, or those
that have the potential to cause harm are continued
indefinitely.
The National Institute for Health and Care
Excellence (NICE) states that 6.5% of non-elective
admissions are attributed to adverse drug reactions
and, of these, 72% are potentially avoidable, costing
the NHS approximately £530 million/year. 1 Hospital
admissions not only increase demands on Accident
and Emergency departments and bed capacity,
but also have a detrimental effect on the patient;
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deconditioning is a well-established and harmful
effect of what could be a potentially avoided
hospital admission. 2 In addition, the World Health
Organization has shown that more than 50% of
medicines are taken incorrectly; either through
overuse or underuse, which, in turn, can cause
harm and waste. 3 These factors demonstrate the
growing need for pharmacy input into a patient’s
care, particularly for those who are elderly and often
present with multimorbidities and polypharmacy.
These are strong risk factors for inappropriate
prescribing, adverse drug reactions, adverse drug
events and morbidity and can all lead to patient
harm and possible hospitalisation. 4,5
Deprescribing, for example, within the care
home environment, has demonstrated cost savings
through admissions avoidance and reduced