Report: IPC Conference Presentation by Professor Tony Avery OBE, National Clinical Director for Prescribing
In today’s world, it is widely accepted that medicines do a lot of good. Over the years, they have significantly reduced mortality rates and increased human life expectancy. In particular, antimicrobials have been a game-changer, making specific medical procedures possible, such as complicated surgeries, critical care, premature infant care, and organ transplants. However, sometimes medicines do more harm than good, and over-prescribing can be a significant issue. The growth in prescription items per head of population in England over 20 years has doubled, which may include inappropriate prescribing.
As the world grapples with the COVID-19 pandemic, there is growing concerned about overprescribing antibiotics and other medications. Overprescribing has become a significant issue in healthcare that can lead to adverse drug reactions, antibiotic resistance, and other negative consequences.
In April 2023, Professor Tony Avery, GP and Professor of Primary Health Care, National Clinical Director for Prescribing (NHS England), and NIHR Senior Investigator, spoke at the Infection Prevention and Control Conference at the National Conference Centre in Birmingham. During his speech, Avery highlighted the importance of tackling overprescribing to improve patient care.
The overuse of medicines, including antimicrobials, is a growing problem that can lead to harm, waste, and increased healthcare costs. The UK government commissioned the National Over-Prescribing Review to address this issue, published in September 2021. The report includes 20 recommendations to reduce over-prescription, promote non-medication alternatives, and improve patient outcomes. These recommendations are categorized into seven different themes:
Working with Patients, Carers, and the System
This involves promoting cultural change and increasing awareness among patients and caregivers about the appropriate use of medications. The Polypharmacy program, run by the Academic Health Science Network, is an example of such an initiative.
Improving and Implementing Prescribing Processes, Reviews, and Guidance
This theme focuses on updating guidance on repeat prescribing systems and incorporating patient reviews and medication stoppages into NICE guidelines.
The Use of Digital Technologies
The Interoperable Medicines Program aims to improve communication between primary and secondary care providers and other relevant healthcare professionals to improve medication management.
Developing education and training
This theme aims to enhance the training of healthcare professionals, including GPs, pharmacists, and nurses, to improve medication management, prescribing practices, and patient communication.
Research and Evaluation
This theme promotes research to inform future interventions to reduce over-prescription and improve patient outcomes. This includes evaluating current prescribing practices and identifying areas for improvement.
Reducing Variation
This involves standardizing prescribing practices and reducing variation in medication use across different healthcare settings.
Reducing Medication Waste
This theme aims to reduce the amount of wasted medications by improving medication management, reviewing prescription practices, and promoting the use of non-medication alternatives.
One of the primary ways to prevent overprescribing is by using non-medicine alternatives. Avery states, “We must shift our focus from prescribing medications as a first-line treatment option. Non-medicine alternatives can be just as effective in many cases.” These alternatives can include lifestyle changes such as exercise or diet modifications or non-pharmacological treatments such as physical or cognitive-behavioral therapy.
The speaker discussed one scenario involving a patient prescribed antibiotics for a viral infection. The speaker notes that “antibiotics are ineffective against viruses” and that prescribing them unnecessarily can contribute to antibiotic resistance. Another scenario involves a patient being prescribed multiple medications for different conditions. The speaker notes that “polypharmacy can increase the risk of adverse drug reactions” and that it is essential for healthcare providers to consider potential interactions between medications.
Improving prescribing practices is another way to address overprescribing. This can include reducing unnecessary prescriptions or ensuring patients receive the appropriate medication at the correct dose. Avery stressed the importance of evidence-based prescribing decisions that consider individual patient needs. “By doing so, we can reduce harm and waste while improving outcomes,” he said.
The increased number of prescription items dispensed since 1996 has led to concerns about overprescribing and its impact on patient care. “We need to be mindful of the potential risks associated with overprescribing,” warned Avery. “Reducing overprescribing can improve patient care and ensure that medications are used appropriately.”
In conclusion, tackling overprescribing is crucial to improve patient care. Using non-medicine alternatives and improving prescribing practices can reduce harm and waste while improving outcomes. Avery emphasized, “We need to take action now to address overprescribing and ensure that patients receive the best possible care.”
As healthcare providers, we are responsible for ensuring that patients receive the best possible care. By tackling overprescribing, we can fulfill this responsibility and improve patient outcomes. Avery said, “We need to ensure that prescribing decisions are evidence-based and consider individual patient needs.” Doing so can create a more effective and efficient healthcare system that prioritizes patient care above all else.
Antimicrobial stewardship is an essential aspect of the National Over-Prescribing Review, given the concern around antimicrobial resistance. Kieran Hands, from NHS England, will discuss this in more detail. Still, in summary, the aim is to promote the appropriate use of antibiotics and reduce their overuse to prevent the development of antimicrobial resistance.
