A Review of the Potentially Inappropriate Prescribing in Frail Patients at The Mill Medical Practice

Abstract

Introduction: Elderly care is becoming increasinglycomplex due to the increasing age of the population leadingto higher disease burden. The British Geriatric Society (BGS),defines frailty as a 'distinctive health state related to theageing process in which multiple body systems graduallylose built in reserves' (1). Patients included in this study wereboth male and female selected at random. Age included thoseover the age of 65 with a frailty score over 0.25 to includemoderately and severely frail.Aim: To identify frail patients at The Mill MedicalPractice and assess the appropriateness of their prescribedmedication using statistically validated medication reviewtools. This included looking at STOP/START interventions,anti-cholinergic burden and frailty index.Methods: Moderately and severely frail patients were categorised using the electronic frailty index within the emissystem at the GP surgery. 20% of patients from each groupwere chosen at random to have their medication assessedusing the review tools. The tools included: STOPP/START,Anticholinergic burden calculator, PrescQIPP falls risk,NICE guidelines, and adapted RiO scoring tool.Results: In total, the medications of 113 patients were assessed using the review tools. 38% of patients had a STOPPintervention and 63% had a START intervention. Themost commonly inappropriately prescribed medicine wasFurosemide for both patient groups. It has an anticholinergicburden score of 1 and moderate falls risk. Overall, 16% ofpatients had a drop of one in anticholinergic burden score.Also, an increase in 23% of patients having a score of zero. Conclusion: This study was successful in identifying thosepatients that could have changes made to their medicationto improve quality of care. Anticholinergic burden can havedetrimental effects in those frail patients leading to physicaland cognitive changes. Decreasing anticholinergic burden infrail patients is clinically important due to the risk of theseadverse effects such as confusion, dizziness which couldresult in injury. Even a small increase in in anticholinergicburden score can have serious effects for these frail patientsresulting in a hospital admission (2). By decreasing the medicine burden on frail patient this can reduce issues associated with anticholinergic burden and other medicine relatedissues in turn improving quality of life. Despite the use ofmedication review tools which try to prevent inappropriateprescribing, this is still an occurrence within the frail population and primary care. This could be due to: lack of time,limited resources available, patients not wanting to change,prescriber willingness to change medication and availabilityof healthcare professionals to do medicine reviews. Futurework could include looking in depth at the ideas explored in this study such as anticholinergic burden and the long termseffects of this on patients.