A missed opportunity - hospital doctors must stop 'risky' medicines

Oct 14, 2021

3 min

Hospital doctors and pharmacists should stop ‘risky’ medicines before patients leave hospital - according to researchers at the University of East Anglia.

One in two older people are prescribed a medicine which over time has become inappropriate or unnecessary.

In a recent National Overprescribing Review titled ‘Good for you, good for us, good for everybody’, the government called on doctors and pharmacists working in GP surgeries to tackle the problem of overprescribing.

But research from UEA’s School of Pharmacy has found that nine out of 10 older hospital patients and their family believe that inappropriate or unnecessary medicines should also be spotted and stopped whilst they are in hospital.

And the team say that by the time people are back under their GP care, a major opportunity has been missed.

Prof Debi Bhattacharya, from UEA’s School of Pharmacy, said: “We know that half of older people admitted to hospital arrive having been prescribed a medicine that over time has become inappropriate for them. These medicines will have more risks than benefits.

“And their side effects cause problems, like making them feel drowsy, nauseous or have trouble getting to sleep. These problems impact a person’s quality of life to the extent that they can cause re-hospitalisation.

“Our research has shown that very few patients have one of these ‘risky’ medicines stopped whilst in hospital.

“Continuing medicines when they are not needed unnecessarily harms people and wastes NHS money.

“The time is right to undertake research into ways of safely increasing the number of inappropriate and unnecessary medicines that are stopped,” she added.

To tackle the problem, Prof Bhattacharya is leading a £2.4 million trial to stop risky medicines in hospital - in collaboration with researchers at the Universities of York, Newcastle, Leeds and Leicester, the Norfolk and Norwich University Hospital and Addenbrooke’s Hospital in Cambridge.

Patient and Public Engagement lead for CHARMER, Katherine Murphy, said: “We are working with hospitals and GP organisations across England to see whether the new strategy works, helps people, causes no harm, and is good value for the NHS.

“And for this trial to be meaningful to people, we need to make sure that we look at the things that matter to them when testing whether stopping a medicine has had a positive outcome.”

The research team recently surveyed 200 people including patients, informal carers, doctors, nurses, pharmacists, physiotherapists and researchers to find out what they should look at in the trial.

On reviewing the results Katherine Murphy said: “It was good to see that what people really want us to look at is whether patients can do the things that they want to do, not how much patients can do.

“Being able to walk up a flight of stairs, for example, may be important to some patients but not to others. We need to make sure that medicines are prescribed that support people to get the best quality of life. In the trial, we also need to make sure that the way that we stop risky medicines causes no harm and is good value for the NHS.”

For more information about the CHARMER study visit https://www.uea.ac.uk/web/groups-and-centres/charmer/about-the-research

The research has been funded by the National Institute of Health and Social Care research.

You might also like...

Check out some other posts from University of East Anglia

3 min

Major study reveals the lasting impact of Covid lockdowns

New research from the University of East Anglia reveals first-hand the lasting impact that lockdowns may have had on people’s mental and physical health. The UK’s first Covid lockdown was announced by Prime Minister Boris Johnson exactly two years ago today. Just a few days later, researchers at UEA launched a major project to track the mental and physical health of the nation through lockdowns and beyond. More than 1,000 participants carried out daily surveys – with questions on a range of lifestyle behaviours including physical activity, diet, sleep, smoking, drinking, and drug use. Some of the participants were then interviewed by the research team, to try to understand what was happening for people from their own viewpoints. Listen to what they had to say in our oral history project Lockdown Voices. New findings published today show how people responded very differently to social restrictions depending on their existing circumstances. For those who were less well-off to start with, adapting to lockdown was more difficult, and health behaviours typically worsened to a greater extent. In contrast, those who were better off at the start of the pandemic demonstrated faster adaptation and were more able to respond positively to restrictions, for example by taking to online exercise classes. It is likely that any lasting impact to mental and physical health will therefore be much greater for those who were worse off to start with. Those with good social links and healthy behaviours already in place described in their interviews how they were able to adapt to lockdown and thrive, whereas some of the more vulnerable in our communities had fallen into unhealthy spirals. Prof Caitlin Notley, from UEA's Norwich Medical School, said: “When the first lockdown was announced back in 2020, we started surveying participants from around the UK daily. Our initial results showed that people were eating less fruit and veg, getting less exercise and drinking more alcohol. “It quickly became apparent that lockdown may have lasting consequences for the physical and mental health of the nation. “We wanted to see whether people’s lifestyles changed in the long-term so we continued the study by carrying out regular surveys with the participants, and interviewing some people to find out more.” Now, two years on, the team’s results show how health inequalities are likely to have widened. Prof Notley said: “Social restrictions imposed as a result of the coronavirus pandemic have had a significant impact on health behaviours at the individual and population level. “It’s fair to say that all of our participants’ lives were disrupted by lockdown and they were forced to adapt. “But people responded to the lockdowns very differently and their experiences of social restrictions varied considerably. “Fundamentally, people were hindered or helped by their existing support structures and resources, such as access to technology to engage with the outside world, or private outdoor space. “Those people who had good friends, community links and who were already health conscious, were able to respond positively and better able to cope. “They were able to adapt to the ‘new normal’, use technology to keep in touch with friends and relatives, order veg boxes, carry on with a healthy diet and take part in healthy pursuits in new and innovative ways such as online fitness classes or ‘doing Joe Wicks’. “But lockdowns are very likely to have caused a sustained widening of social and health inequalities. “Those who remained in work outside the home, or who were retired, were the least impacted overall. But those who were unemployed, younger, on a lower income, clinically unwell or told to fully shield were particularly impacted by strict restrictions. “For these more vulnerable people, supportive social factors were taken away or severely restricted. Anxiety and depression worsened, and unhealthy behaviours like exercising less, drinking more alcohol, and eating a poor diet increased. “As we work through the ‘roadmap to recovery’, emphasis needs to be placed on a collaborative, community-based approach, with a focus on what makes us well. “Encouraging membership of community exercise groups, for example, may help those most impacted to engage again with healthy behaviours to keep them well. We also need to pay attention to how those who are less well-off responded more negatively to the policy of lockdown, so that lessons can be learnt for the future,” she added. ‘Disruption and adaptation in response to the coronavirus pandemic – assets as contextual moderators of enactment of health behaviours’ is published in the British Journal of Health Psychology.

2 min

'Tangled Up' reveals science and history of Alzheimer's

A new book from leading University of East Anglia dementia expert Prof Michael Hornberger investigates the science and history of Alzheimer's disease. 'Tangled Up - The science and history of Alzheimer's disease' is available as a paperback or e-book. Prof Hornberger researches groups that are at higher risk of developing dementia (because of genetics, lifestyle or their other health condition) and works to help reduce this risk or delay the symptoms of dementia. He also explores the nature of support for those who have been diagnosed with dementia and helping the patients and their families and carers prepare for the future. His background is as a neuroscientist and his work involves using innovative techniques (such as online games and driver behaviour) to identify the spatial or navigation issues that can occur long before before diagnosis of dementia and before the traditional impacts on memory arise. He developed the mobile game Sea Hero Quest that can detect people at risk of Alzheimer's. His work enables early prediction of the likelihood of dementia (sometimes a decade ahead) and the opportunity to manage the onset and reduce risk by as much as 30 per cent. Prof Michael Hornberger, from UEA’s Norwich Medical School, said: “Alzheimer's disease is the most common cause of dementia in the UK. It affects around one in 14 people over the age of 65 and one in every six people over the age or 80 – and it can affect memory, thinking skills and other mental abilities. “I wanted to write a book to help people better understand the science and history of Alzheimer’s disease. “It covers everything from the causes of Alzheimer’s, through to why people with Alzheimer’s ‘live in the past’ and practical advice for how people can reduce the risk of developing it. “At the end of the book, you will have become an Alzheimer’s disease science expert and can use your newfound knowledge to untangle this devastating disease,” he added.

2 min

Flavoured vapes less harmful to young people than smoking, could help teen smokers quit

Flavoured vapes are much less harmful to young people than smoking, and could help teen smokers quit tobacco – according to new research from the University of East Anglia. A new study published today looks at young peoples’ use of vape flavours, reporting the views and experiences of more than 500,000 under 18s. It finds that flavours are an important aspect of vaping that young people enjoy, suggesting that flavoured products may help them switch away from harmful tobacco smoking. But the researchers warn that more needs to be done to make sure that youngsters who have never smoked are not attracted to vaping. Lead researcher, Prof Caitlin Notley, from UEA’s Norwich Medical School, said: “There has been a lot of concern that young people may start vaping because they are attracted to e-liquid flavours, and that it could potentially lead them to start smoking tobacco. “We wanted to find out more about the links between vape flavours, the uptake of vaping among young people, and whether it leads to regular vaping and, potentially, tobacco smoking.” The research team studied all available evidence (58 studies) on young peoples’ use of e-liquid flavours. Prof Notley said: “We found that flavoured e-liquids are an important aspect of vaping that young people enjoy. This suggests that flavoured products may encourage young people to switch away from harmful tobacco smoking towards less harmful vaping. “Flavours may be an important motivator for e-cigarette uptake – but we found no evidence that using flavoured e-liquids attracted young people to go on to take up tobacco smoking. “And we also found no adverse effects or harm caused by using liquid vape flavours. “However, there is also a need to monitor flavour use to ensure that young people who have never smoked are not attracted to taking up vaping. “Ensuring the continued availability of a range of e-liquid flavours is likely to be important in encouraging young people who smoke to switch to vaping as a less harmful alternative,” she added. The team found that the overall quality of the evidence on use of e-cigarette flavours by young people was low. In particular, many studies did not clearly define e-liquid flavours and could not therefore be included within the review. The study was led by UEA in collaboration with researchers at University College London, the University of Bristol and University Hospitals Bristol and Weston NHS Foundation Trust. ‘Youth Use of E-Liquid Flavours – A systematic review exploring patterns of use of e liquid flavours and associations with continued vaping, tobacco smoking uptake, or cessation’ is published in the journal Addiction on November 17, 2021.

View all posts