LLR polypharmacy pilot

In response to the National Overprescribing Review Report (2021) which outlined the need for systemic and cultural changes to enable systems to reduce overprescribing. Leicester, Leicestershire, and Rutland (LLR) Integrated Care Board (ICB) set up a polypharmacy team multidisciplinary (MDT) to identify patients most at risk.

The Challenge

LLR ICB sought to address the issue of overprescribing and inappropriate polypharmacy across the region. These challenges are particularly significant for patients with complex medical needs, where multiple medications can lead to negative outcomes such as an increased anticholinergic cognitive burden (ACB) and the risk of hospital admissions.

There was a need for a targeted approach to evaluate and optimise medication management in primary care settings while improving collaboration between primary and secondary care professionals.

The Solution

HIEM awarded funding to LLR ICB to evaluate a polypharmacy multidisciplinary team (MDT) review service across four primary care networks (PCNs). The pilot included the following key components:

  • Risk Stratification: Identified complex patients most in need of medication reviews using targeted criteria.
  • MDT Clinics: Held virtual clinics attended by a specialist clinical pharmacology consultant, a pharmacist from University Hospitals of Leicester (UHL) NHS Trust, the patient’s GP and/or PCN pharmacist, and sometimes the patient themselves. These discussions co-produced individualised care plans.
  • Follow-Up and Implementation: Recommendations were implemented by the GP and/or PCN pharmacist following shared decision-making with the patient. The UHL pharmacist followed up to evaluate outcomes and provide further advice where needed.

Impact and Outcomes

The pilot demonstrated positive outcomes across several areas:

    • 28% of patients (10 individuals) had a reduction of three or more medicines.
    • Eclipse scores, recorded before and after the MDT polypharmacy review, had a 25% reduction (but could be due to other interventions in addition to the MDT).
    • 63 recommendations were made during the pilot, resulting in one ‘possible’ and nine ‘likely’ avoided admissions.
    • Health economic analysis projected that scaling the approach to 2,612 eligible patients across LLR could result in benefits worth £656,192 and a benefit-cost ratio of 1.25.

Although there was limited staff feedback to report on, the pharmacist indicated they enjoyed working closely with secondary care and that the MDTs enabled them to improve their understanding of medicine-related issues, including dosage and side effects. They also suggested they had received positive feedback from a patient’s family member, who was impressed by the patient-focused nature of the clinics.

Innovation Insights webinar

This evaluation was showcased as part of our Innovation Insights series. The webinar included speakers from the NHS project team and leaders of the evaluation.

Listen back

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