Steve Titmarsh looks at how independent pharmacists can help seniors manage their medications effectively, particularly in cases of polypharmacy…

Pharmacists in the UK are uniquely positioned to play a pivotal role in the care of senior patients, offering accessible, personalised support that addresses their complex health needs.

So, how can pharmacists support the management of chronic conditions and what role of pharmacists in providing preventive care is developing.

Our population is aging, of that there is no doubt. Analysis by the Office for National Statistics suggest that over the next 15 years the size of the UK population aged 85 years and over is projected to increase from 1.6 million (2.5% of the total population) to 2.6 million (3.5%).1

With age comes more illness for many, with the number of comorbid conditions for each individual rising as they age, which is often accompanied by an increasing list of medicines to be taken in an attempt to slow the development or quell the symptoms of such afflictions.

Sadly an increasing number of medicines taken by any one individual is almost always accompanied by the risk of more side-effects as well as a greater risk of drug interactions.2,3

Optimising pharmacotherapy

For pharmacists optimising drug therapy is a key focus for senior patients in particular. The PrescQIPP website has a whole host of information and resources to help understand appropriate polypharmacy and deprescribing and the importance of these strategies for improving patient safety.

For example, there is a flowchart to support appropriate polypharmacy describing a process to fully engage patients in treatment decisions.

Information about high-risk medicines covers topics such as treatments for constipation, prescribing and withdrawing dependence-forming drugs such as benzodiazepines, Z-drugs and antidepressants, fentanyl and non-steroidal anti-inflammatory drugs.

Webinars cover topics such as a structured medication review. And there are articles about award winning initiatives, including a collaborative effort by a team of community, hospital, CCG and GP practice pharmacists who developed and helped deliver a series of webinars to support deprescribing in primary care.4

The Specialist Pharmacy Service provides a similar resource on its website with advice and tools to support medication reviews.5

A number of tools are available to support deprescribing in older patients. For example, the Screening Tool of Older Persons’ Prescriptions (STOPP) version 3 highlights prescriptions that are potentially inappropriate for patients aged 65 years and older.2,6

There is plenty of evidence from around the world that community pharmacists can make a significant difference in optimising pharmacotherapy for senior citizens, along with chronic disease management.

This is not least in terms of supporting their adherence to therapy, helping them understand what their medicines are for and what to expect from them.

Community pharmacists can also contribute to monitoring for side-effects by educating patients what to look out for and encouraging them to report any problems they have.

Community pharmacists can then liaise with other primary care health professionals to alert them to problems patients may be having thus prompting a review and potentially a change to their medication.7,8

Expanding role

The government’s new medicine service initiative specifically recognises the role community pharmacists can play in supporting people in the early days of being prescribed a medicine for a long-term condition such as;

• asthma and chronic obstructive pulmonary disease
• diabetes
• cardiovascular disease
• epilepsy
• glaucoma
• urinary incontinence/retention
• Parkinson’s disease
• osteoporosis
• hypercholesterolaemia.9

It certainly seems to be effective: a study funded by the NIHR (National Institute for Health and Care Research) Policy Research Programme and published in the BMJ Quality & Safety journal found that four years after the scheme was launched in 2011 patients were effectively supported with adherence to new medications and that the scheme had saved the NHS £558 million.10,11

Community pharmacies are taking an increasing role in public health initiatives and relieving GPs of some of their workload. The Company Chemists’ Association estimates, for example, that almost half (46%) of all COVID-19 vaccines were provided by community pharmacies.12

Community pharmacy is helping to find some of the estimated 5.5 million people who have undiagnosed hypertension in England as part of the hypertension case-finding service by targeting people who do not routinely see their GP or use other NHS services.13

In the first year of the NHS Community Pharmacy Blood Pressure Check Service, pharmacies conducted nearly 600,000 blood pressure checks, preventing 600 future heart attacks and strokes, according to the Company Chemists’ Association’s calculations.

Of these checks, 44 per cent were delivered in the 30 per cent most deprived areas in England. By 2026, the Company Chemists’ Association estimates that 15 million blood pressure screenings will have taken place, preventing up to 15,000 heart attacks and strokes.14 

Future roles

Some research highlights a potential role for community pharmacists to fill the ‘osteoporosis treatment gap’. The disease mainly affects older people so the burden attributed to it is likely to grow with our aging population.

Estimates suggest that one in three women and one in five men over 50 years of age will be directly impacted by osteoporosis during their remaining life. Many people are untreated, particularly those with fragility fractures.

A review of studies from around the world suggests pharmacists can help in a number of ways: helping to raise public awareness of the disease; screening to help identify people at risk; improving adherence, and reviewing patients’ medicines to encourage deprescribing of medicines that may be associated with falls and therefore risk of fractures in those with osteoporosis.15

Community pharmacists can also advise on healthy lifestyles, including diet and exercise.16

Conclusion

Community pharmacists’ role has expanded significantly in recent years with the growing acknowledgement of their unique place in the community and accessibility for the public.

The House of Commons Health and Social Care Committee recently acknowledged that ‘community pharmacy has fantastic potential to improve access to healthcare and alleviate pressures on the wider health service’.17

Formal research evidence shows that community pharmacists can make a difference for senior patients, particularly in terms of helping them manage new medicines they are prescribed to attain the best outcomes possible.

But it does not end there. Some believe community pharmacy can make a greater contribution still.

For example, Community Pharmacy England chief executive Janet Morrison told the House of Commons Health and Social Care Committee how blood pressure checks could be expanded ‘into hypertension management, cholesterol management and atrial fibrillation’.17

References

1. Office for National Statistics. National population projections: 2021-based interim (www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationprojections/bulletins/nationalpopulationprojections/2021basedinterim#:~:text=2.-,UK%20population,(a%2010.2%25%20increase);accessed October 2024).

2. O'Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. Eur Geriatr Med 2023;14(4):625–32.

3. British National Formulary. Prescribing in the elderly (https://bnf.nice.org.uk/medicines-guidance/prescribing-in-the-elderly; accessed October 2024).

4. PrescQIPP. Polypharmacy and deprescribing (www.prescqipp.info/our-resources/webkits/polypharmacy-and-deprescribing; accessed October 2024).

5. Specialist Pharmacy Service. Using tools to support medication review (www.sps.nhs.uk/articles/using-tools-to-support-medication-review; accessed October 2024).

6. Screening Tool of Older Persons’ Prescriptions (STOPP) version 3 (https://static-content.springer.com/esm/art%3A10.1007%2Fs41999-023-00777-y/MediaObjects/41999_2023_777_MOESM1_ESM.pdf; accessed October 2024).

7. Christopher CM, Bhuvan KC, Blebil A, et al. Clinical and Humanistic Outcomes of Community Pharmacy-Based Healthcare Interventions Regarding Medication Use in Older Adults: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2021;9(11):1577. 

8. Okoro RN, Nduaguba SO. Community pharmacists on the frontline in the chronic disease management: The need for primary healthcare policy reforms in low and middle income countries. Explor Res Clin Soc Pharm 2021;2:100011.

9. NHS Business Services Authority. Advanced Service Specification – NHS New Medicine Service (NMS) (www.nhsbsa.nhs.uk/sites/default/files/2021-10/B0936%20%20Service%20Specification%20%20NHS%20New%20Medicine%20Service%20%28NMS%29%20advanced%20service%20%28003%29.pdf; accessed October 2024).

10. National Institute for Health and Care Research. Supporting patients to take their new drugs correctly (www.nihr.ac.uk/story/supporting-patients-take-their-new-drugs-correctly; accessed October 2024). 

11. Elliott RA, Boyd MJ, Salema N-E, et al. Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service. BMJ Qual Saf 2016;25:747–58.

12. Company Chemists’ Association. The growing role of community pharmacy in COVID vaccination programmes (https://thecca.org.uk/wp-content/uploads/2023/10/The-growing-role-of-community-pharmacies-in-COVID-vaccination-programmes-2.pdf; accessed October 2024).

13. Community Pharmacy England. Briefing: 036/23: Briefing for pharmacy teams – the Hypertension Case-Finding Service (https://cpe.org.uk/wp-content/uploads/2023/11/Briefing-036.23-Briefing-for-pharmacy-teams-the-Hypertension-Case-Finding-Service.pdf; accessed October 2024).

14. Company Chemists’ Association. Community pharmacies expected to deliver 15m blood pressure checks by 2026 (https://thecca.org.uk/community-pharmacies-expected-to-deliver-15m-blood-pressure-checks-by-2026; accessed October 2024).

15. Laird C, Benson H, Williams KA. Pharmacist interventions in osteoporosis management: a systematic review. Osteoporos Int 2023;34:239–54.

16. Royal Osteoporosis Society. Ask your pharmacist about osteoporosis (https://theros.org.uk/blog/ask-your-pharmacist-about-osteoporosis/#:~:text=They%20can%20provide%20lifestyle%20information,help%20recover%20from%20a%20fracture; accessed October 2024).

17. House of Commons Health and Social Care Committee. Pharmacy. Third Report of Session 2023–24 (https://publications.parliament.uk/pa/cm5804/cmselect/cmhealth/140/report.html; accessed October 2024).