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
• Long 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!
• Review 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