8. Effective medicines management

What is it?

Medicines management supports better and more cost-effective prescribing in primary care, as well as helping patients to manage medications better. Good medicines management can help to reduce the likelihood of medication errors and hence patient harm.

Why is it important?

• There is a considerable body of evidence from the point of view of patient safety, service efficiency and cost that medicines management needs to be improved.
• Prescribing costs are rising at a relentless rate – about 7 per cent per year in real terms – and account for 12 per cent of the overall NHS budget. In 2010, the annual drugs bill in primary care alone was around £8.6 billion (NHS Business Services Authority, Prescription Pricing Division 2010).
• Medication errors occur in up to 11 per cent of prescriptions, mainly due to errors in dosage (Sanders and Esmail 2003).
• Around 7 per cent of all hospital admissions have been attributed to, or associated with, adverse drug reactions – with up to two-thirds of these being preventable (Pirmohamed et al 2004). Adverse reactions are particularly common among vulnerable groups, such as, frail older patients in nursing homes (Gurwitz et al 2005).
• Between one-third and one-half of all medication prescribed for long-term conditions are not taken as recommended (Nunes et al 2009).

What is the impact?

• The evidence cited above suggests that improved medicines management could be expected to have a high impact in terms of patient experience and health outcomes. There is good evidence that guidance and peer review can support improvements in the quality and safety of prescribing (Duerden et al 2011), although achieving major improvements in patient compliance may be more difficult (Haynes et al 2008).
• The impact on costs could also be substantial, given the levels of drug wastage, opportunities to improve the cost-effectiveness of prescribing certain drugs, and the high numbers of preventable drug-related emergency hospital admissions. For example, standardising prescribing practices for certain treatments (such as low-cost statins) could save the NHS more than £200 million a year (NAO 2007).

How to do it

There are a number of techniques available that GPs will be in a prime position to implement:

• medication reviews, usually in general practice, that seek to ensure prescribing standards are being met – for example, through practice-based audits linked to peer review of prescribing practices and outcomes
• use of IT and decision-support tools to support best practice in prescribing by professionals, and to help reduce medication errors
• pharmacist and nurse-led interventions that provide educational information and outreach services to reduce prescribing and monitoring errors among high-risk patients (Avery 2010)
• use of pharmacy technicians to support practices to improve their prescribing practice by conducting systematic audits, evaluating patients and recommending changes to medication
• improved systems to support safe transfer of information on patient medication at admission and discharge
• providing clinicians with benchmarked information on prescribing performance.

Useful resources

• The National Prescribing Centre website contains a number of guides to support effective medicine management.
• NeLM is the largest medicines information portal for health care professionals in the NHS: National electronic Library for Medicines (NeLM)

For further information

• Download all ten priorities: Transforming our health care system
• You can also find all the references mentioned here in that version
• Listen to Candace Imison talk through the ten priorites in our audio slideshow