Overprescribing

Medication contributes 60% of the carbon footprint of primary care, yet we know that medications often aren’t taken as prescribed, are wasted, or can cause harm to patients.

NICE estimates that between a third to half of medications for long-term conditions are not taken as prescribed and medication harms are estimated to be responsible for over 180 000 hospital bed days per year. Around 1 in 5 hospital admissions in over-65s and around 6.5% of total hospital admissions are caused by the adverse effects of medicines. The more medicines a person takes, the higher chance there is that one or more of these medicines will have an unwanted or harmful effect.

GPs and clinical staff responsible for prescribing medication can help reduce overprescribing by taking the following actions:

• Undertake structured medication reviews at least annually.
• Prioritise patients who are at highest risk of medication harm, including elderly or frail patients, those on more than 10 medications and patients on high-risk medications such as opiates, gabapentinoids, hypnotics, anticholinergics.
• Use available tools to help identify appropriate deprescribing such as the IMPACT tool and deprescribing algorithms on PresQIPP and Anticholinergic burden score.
• Consider providing a shorter prescription when initiating a new medication to avoid waste if it is not tolerated by the patient.
  Educate patients with regards to ordering medication to ensure they are only ordered when needed and reduce the risk of stockpiling.
• Work collaboratively with community pharmacies and care homes to reduce over-ordering of medication.