Quality statement 4: Reviewing medicines and other treatments

Quality statement

Adults having a review of their medicines and other treatments for multimorbidity discuss whether any can be stopped or changed.

Rationale

Once preferences and priorities have been explored and any burdens of treatment understood, a healthcare professional and patient can review medicines and other treatments and consider whether they are serving a person's interests. This review might lead to treatments being stopped or changed, or new treatments being started. A family member, friend, or independent advocate may help a person to explain their preferences and better understand their choices. Discussions should include agreement on how frequently future reviews should happen to take account of changes in circumstances.

Quality measures

Structure

Evidence of local arrangements to ensure that adults having a review of their medicines and other treatments for multimorbidity discuss whether any can be stopped or changed.

Data source: Local data collection from service protocols.

Process

Proportion of adults having a review of their medicines and other treatments for multimorbidity who discussed whether any could be stopped or changed.

Numerator – the number in the denominator who discussed whether any treatments could be stopped or changed.

Denominator – the number of adults having a review of their medicines and other treatments for multimorbidity.

Data source: Audit of health records.

Outcome

a) Number of adverse events from medicines in adults with multimorbidity.

Data source: Audit of health records.

b) Adults having a review of their medicines and other treatments for multimorbidity feel that the decisions about their treatments have taken into account the outcomes they felt were important.

Data source: Patient survey.

c) Adults having a review of their medicines and other treatments for multimorbidity feel that their treatment burden is reduced.

Data source: Patient survey.

What the quality statement means for different audiences

Service providers (such as primary care services) ensure that reviews of medicines and other treatments for adults with multimorbidity include discussing whether any can be started, stopped or changed and the frequency of future reviews.

Healthcare professionals (such as GPs and practice nurses) discuss with adults having a review of their medicines and other treatments for multimorbidity whether any can be stopped or changed to better serve the person's interest. They agree a frequency for ongoing reviews and record this in the individualised management plan.

Commissioners (clinical commissioning groups and NHS England) commission services in which adults having a review of their medicines and other treatments for multimorbidity discuss whether any can be started, stopped or changed and the frequency of future reviews.

Adults with multimorbidity who are having a review of their treatments with their GP or practice nurse discuss if some treatments can be stopped or changed. The aim of this is to improve the person's quality of life.

Source guidance

Multimorbidity: clinical assessment and management (2016) NICE guideline NG56, recommendations 1.5.2 and 1.6.11

Definitions of terms used in this quality statement

Review of their medicines and other treatments for multimorbidity

A review of medicines and non-pharmacological treatments, such as diets and exercise programmes, that takes account of likely benefits and harms for the individual patient, and outcomes for the patient.

[Adapted from NICE's guideline on multimorbidity, recommendation 1.5.2 and full guideline]

Multimorbidity

The presence of 2 or more long-term health conditions where at least 1 of these conditions must be a physical health condition.

Long-term health conditions can include:

  • defined physical and mental health conditions such as diabetes or schizophrenia

  • ongoing conditions such as learning disability

  • symptom complexes such as frailty or chronic pain

  • sensory impairment such as sight or hearing loss

  • alcohol and substance misuse.

Multiple mental health problems and no physical health conditions are not included. Care for people with only mental health problems would largely be delivered by psychiatric services and is not covered by this quality standard.

[Adapted from NICE's guideline on multimorbidity, recommendation 1.1.1 and full guideline]

Stopped or changed

Stopping, changing or starting of medicines and non-pharmacological treatments.

[Adapted from NICE's guideline on multimorbidity, recommendations 1.6.11 and 1.6.15]

Equality and diversity considerations

Healthcare professionals should take into account the needs of adults who may find it difficult to fully participate in a review of medicines and other treatments (for example, those with learning disabilities, cognitive impairment or language barriers). They should also assess a person's knowledge, skills and confidence in managing their own health and care. Reasonable adjustments should be made such as providing information in a format that suits their needs and preferences, and providing access to an interpreter or advocate if needed. For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.