55RATIONAL PRESCRIBING: POLYPHARMACY AND OPTIMAL PRESCRIBING TEACHING FOR FOUNDATION YEAR TWO (FY2) DOCTORS

Abstract

Introduction: Complex drug treatment regimens in elders with multiple co-morbidities are common. Such regimens may be appropriate and improve life expectancy and quality of life. However, harm may occur with "problematic" polypharmacy i.e. more adverse effects, impaired concordance, and medicine wastage (NICE: http://nice.org.uk/ guidance/ktt18). As part of a five-session course for FY2 learners, we delivered teaching focusing on "Prescribing in the Elderly". This was further explored in the major topic areas tackled (delirium, dementia, falls, continence and complexity) through lecture material and group activities. Method(s): The initial session comprised a lecture and discussion of two cases facilitated by a registrar and consultant. Pre- and post-programme questionnaires examined attitudes, confidence and knowledge (with multiple-choice questions (MCQ) matched to material embedded within the major topic sessions). Result(s): 25 trainees attended the initial session. Key areas trainees identified difficulties with included polypharmacy and how to prioritise treatments. Following the initial session, 92% (23) of trainees felt better prepared to manage polypharmacy. Trainees stated their practice would change by including the use of the STOPP/START tool (O'Mahony D et al. Age and Ageing 2014; 44(2): 213-218), performing medication reviews, and considering anticholinergic burden. 25 trainees completed the pre-programme questionnaire and 31 the post-programme questionnaire. Trainee confidence in performing a medication review rose from 72% to 93%. MCQ scores pre- and post-intervention and were 55.5% and 51.4% respectively. However, only 5 learners attended all the sessions. Conclusion(s): Trainees recognise that older patients are complex, and that polypharmacy is a challenge. After the teaching intervention trainees were more confident in managing this challenge. MCQ performance did not improve. This may be due to the low percentage attending all the sessions due to on-call commitments and leave. Thus, we will develop a study guide (including case studies) to boost the utility of the course and reevaluate next academic year.