29.11.13
The King’s Fund calls for more generalist doctors
Policy, training and clinical practice has failed to adapt to a significant increase in the number of patients taking multiple prescription drugs, The King’s Fund has warned.
The higher proportion of multiple prescriptions reflects the large number of complex or multiple long-term conditions, and an increasingly frail and elderly population.
A new report sets out the need to take an evidence-based approach to polypharmacy and to adapt systems to the need for multiple prescriptions.
The King’s Fund has called for better training, more research set in the context of multiple diseases, improved systems to flag problematic polypharmacy, and regular reviews of medication.
The NHS should be moving away from increased specialisation towards a focus on multi-morbidity to deliver more coordinated care, it urged.
Martin Duerden, the report’s lead author, said: “Currently patients may still be treated in silos where one specialist doctor will look after their care for diabetes, another for their heart condition and a third for their asthma. They will then be prescribed medicines for each condition but these are often not considered in the whole. We need more generalist doctors able to understand a patient’s medicine intake in its entirety and how they are managing, especially if they have to take numerous medicines at different times in the day.
“A sensible way forward might be to identify those taking ten or more medicines and focus on them first. Their medicine intake should be regularly reviewed so that as well as the option of adding a medicine as a condition worsens, they can also scale back or even stop treatment – particularly recognising that end-of-life quality applies to chronic conditions as well as cancer.”
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