Prescribing for Population Health: Problematic Polypharmacy: Prescribing Cascades Evidence Evaluation

Prescribing for Population Health (PPH) is an ongoing series that aims to support ICSs to improve the health of the populations they serve.

Problematic polypharmacy is a significant concern with overprescribing and occurs where the prescribing of multiple medicines is either inappropriate or where the intended benefit of the medication is not realised.

The publication aims to raise awareness of potential prescribing cascades and to highlight resources, tools, and strategies to help identify, prevent, and resolve inappropriate cascades.

February 2023 Newsletter

Prescribing support newsletters aim to inform readers of work done by the unit and work in progress, to help tailor local work plans and highlight any ‘topical’ issues in prescribing or medicines management.

If you have any suggestions for future topics for the newsletter, then please contact nuth.nyrdtc.rxsupp@nhs.net

This month’s edition focuses on RDTC resources to help you make the most of your budget, updates to the cost comparison charts, the voluntary recall of certain FreeStyle Libre 2 sensors, and an E-learning programme on internet safety, suicide, and self-harm. It highlights recent publications from the RDTC including a series of publications as part of the Polypharmacy and Overprescribing theme reviewing opioid prescribing, and a Prescribing Bulletin looking at the budget impact of Metformin immediate release 1g tablets. It also includes another in the series of “Meet the Team” where you can get to know the people behind the work we do. There is also information on some key medicines availability issues and serious shortage protocols

Prescribing for Population Health – Polypharmacy and Overprescribing: Opioids

In recent years, there has been increasing concern regarding the overprescribing of opioids and associated harms. The RDTC has produced a series of publications as part of the Polypharmacy and Overprescribing theme reviewing opioid prescribing:

Each publication includes considerations and interventions for medicines optimisation teams and health systems. To avoid duplication across this series of overprescribing and polypharmacy opioid publications, the suggested actions have only been listed in the most relevant theme but may apply across all. We recommend reading all parts of the series sequentially to ensure the breadth of potential actions are known. The publications can be accessed using the links below:

PPH 3. Polypharmacy & Overprescribing: Opioid patient populations:

This publication aims to support greater understanding of the patient populations prescribed opioids and the inter-relationships and dependencies between prescribing and the available metrics.

PPH 4. Polypharmacy & Overprescribing: Opioid patient demographics:

This publication aims to support greater understanding of the demographics of the patient populations prescribed opioids.

PPH 5. Opioid population health management:

This publication aims to support greater understanding of the population health management of patients prescribed opioids, specifically in terms of deprivation level and the impact on sustainability and climate change.

Prescribing Bulletin: Budget impact of metformin 1g immediate release tablet prescribing

The purpose of this bulletin is to highlight the rapid increase in price of metformin 1g tablets over the last year, and to raise awareness of the difference in price of metformin 1g immediate release (IR) tablets compared with 500mg IR tablets. It considers the potential budget impact to primary care of prescribing metformin 1g IR tablets across the ICSs in the North East & Yorkshire region and Greater Manchester.

Formulary assessment tool: Morphine sulfate (Actimorph) orodispersible tablets

Formulary assessment tools are templates to support local decision making. They list NICE guidance, MHRA safety advice, and other relevant high quality advice and guidelines relevant to making decisions for local formularies.

The templates are pre-populated with useful information to reduce duplication of effort, with space for the addition of local information as appropriate. The purpose of the document is to support consistent decision making by formulary groups and APCs.

The Formulary assessment tool for morphine sulfate orodispersible tablets (Actimorph) can be found here.

December 2022 Newsletter

Prescribing support newsletters aim to inform readers of work done by the unit and work in progress, to help tailor local work plans and highlight any ‘topical’ issues in prescribing or medicines management.

If you have any suggestions for future topics for the newsletter, then please contact nuth.nyrdtc.rxsupp@nhs.net

This month’s edition focuses on polypharmacy, influenza in the community – prescribing antivirals, group A streptococcus in children – advice for clinicians, and the MHRA review on the safe use of valproate. We also include recent publications from the RDTC and another in the series of “Meet the Team” where you can get to know the people behind the work we do. There is also information on some key medicines availability issues and serious shortage protocols.

Strategic Insight: Polypharmacy and overprescribing: an overview

Strategic Insight reports are designed to support strategic objectives and planning by Integrated Care System leaders. Through the analysis of data and communication with key stakeholders across the ICS, interventions to be undertaken by the ICS are proposed to Integrated Care Boards or associated committees.

This report provides an update on key primary care prescribing trends in the North of England with respect to polypharmacy, in order to support primary care teams in identifying key groups who may benefit from a structured medicines review.

Formulary assessment tool: Trifarotene (Aklief)

Formulary assessment tools are templates to support local decision making. They list NICE guidance, MHRA safety advice, and other relevant high quality advice and guidelines relevant to making decisions for local formularies.

The templates are pre-populated with useful information to reduce duplication of effort, with space for the addition of local information as appropriate. The purpose of the document is to support consistent decision making by formulary groups and APCs.

The Formulary assessment tool for trifarotene (Aklief) can be found here.

Comparison table: DPP-4 inhibitors (Gliptins)

Comparison table documents are designed to support prescribers and medicines management teams to maximise health gains through the optimum use of medicines within a specific therapeutic area.

There are currently five dipeptidyl peptidase-4 (DPP-4) inhibitors (or gliptins) available in the UK for the management of type 2 diabetes mellitus. There are a number of differences between the DPP-4 inhibitors in terms of licensing, interactions, renal impairment dose adjustment, hepatic impairment dose adjustment, and cost. This comparison table allows prescribers and other healthcare professionals to easily compare the characteristics of these medicines.

October 2022 Newsletter

Prescribing support newsletters aim to inform readers of work done by the unit and work in progress, to help tailor local work plans and highlight any ‘topical’ issues in prescribing or medicines management.

If you have any suggestions for future topics for the newsletter, then please contact nuth.nyrdtc.rxsupp@nhs.net

This month’s edition covers the RDTC’s Climate Emergency declaration, Pill Swallowing – a skill for life, Metolazone preparations and safety considerations, and the second in the series of “Meet the Team” where you can get to know the people behind the work we do. We also cover the Price concessions and the Discount Deduction scheme, World Antimicrobial Awareness Week, and a guide to the COVID-19 autumn booster. There is also information on the changes to the Medicines Information Service, and some key medicines availability issues.