Prescribing Health | QCS

Prescribing Health

October 7, 2016

I admired a recent TV documentary where Dr Chris van Tulleken tried to demonstrate to GP’s and their patients that medicines were over-prescribed. He said they are often unnecessary, and actually harmful. Painkillers, antidepressants and antibiotics are too readily prescribed because of pressure from patients, workloads, and sadly inducements from pharmacy companies.

It was a radical message, and he teamed up with a GP practice in order to demonstrate his alternatives. The results were enlightening: several patients who had been suffering chronic pain or depression had been receiving regular medication for years. He showed that these were often having only a placebo effect, and could be harming people’s health. It could make their recovery difficult, if not impossible.

A Miracle Cure for Some

His miracle cure? Motivating people to change their lifestyle, with regular exercise as the focus. He also ensured that tapering off of large regular repeat prescriptions for the individual was carefully monitored. In several patients, the results were astonishing, where people recovered from their conditions almost completely, and reduced or eliminated their medicine intake.

Of course, it would take major change to provide motivation for healthy exercise as a way to recovery for many people. Instead, GP’s are understandably pressured into prescribing medicines. One change would mean increasing the length of consultation time, which at present seems to sit at ten minutes. There is little time to assess, let alone change lifestyles.

Over Medication in Social Care

We can all do our bit to reduce the harm that over use of medication can often cause. This is particularly so in social care. In one of my first jobs in care of the elderly, I was shocked to see people with too many medications. Some had a list of medications in their support plans which filled most of a page. The risk of side effects and unfavourable interactions of these regimes were very high.

There is good guidance from the Royal Pharmaceutical Society and from the Care Inspectorate on Medicine care planning.  Only appropriate medicines should be prescribed, only for as long as they needed, and they must be regularly reviewed.

What We Can Do

Not reviewing medication brings the risk of poly pharmacy. The unfavourable side effects of one medication are countered by yet another prescribed medication, resulting in a vicious circle of over-medication.

In social care we need to ensure that the people we care for are able to discuss and resolve any medication issues with the prescriber. Continued medication must be regularly reviewed. If the condition for which the medication clears up, the prescriber must be informed. If the person is not able to manage, then good care clearly requires that the person is supported to have appropriate professional input.

Following the professional guidance will help us all to reduce over reliance on medicine, and to help people to lead more active lives with better health.

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Tony Clarke

Scottish Care Inspectorate Specialist

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