New digital tools essential to reduce overprescribing, review finds

Inability to access patient records and the lack of digital interoperability contribute to the problem of over-prescribing, a government review has found.

It described overprescribing as a “serious problem in health systems internationally that has grown dramatically over the last 25 years.”

Dr Keith Ridge, chief pharmaceutical officer and author of the review, said: “Medicines do people a lot of good and this report is absolutely not about taking treatment or services away from people where they are effective. But medicines can also cause harm and can be wasted.”

Over-prescribing has two main causes, the review found.

The first is systemic. As well as the problems cited with inaccessible patient records and digital interoperability, it  includes single-condition clinical guidelines and an absence of alternatives to prescribing a medicine.

The second is a “healthcare culture that favours medicines over alternatives and in which some patients struggle to be heard.”

Over-prescribing could lead to “more hospital visits and preventable admissions, even premature deaths,” the review said. It noted that overprescribing “may disproportionately affect Black, Asian and Minority Ethnic communities and those who are more vulnerable, such as the elderly and those with disabilities.”

There was also a cost to wasted medicines, the review added. While recent initiatives by the NHS have helped stem the growth rate of overprescribing it remains at “unacceptable” levels, and the review estimated that 10% of the total number of prescription items in primary care need not have been issued.

A need for digital decision-support tools

Electronic health records currently use digital tools to guide prescribers towards specific prescribing decisions, with the aim of encouraging safe, appropriate and cost-effective treatment. The review pointed out, however, that there has been “no assessment of the quality of these digital tools, no national standards relating to their design or technical implementation, and no large-scale monitoring or evaluation of their impact on clinical care.”

The review made several recommendations for addressing the problem, including a number relating to the use of digital technology. It said that NHSX and NHS Digital should:

• Work with IT providers for GP practices to develop templates that support referrals for “culturally competent, evidence-based alternatives to a medicine.”
• Ensure the NHS website and the NHS App give people culturally competent information about their medication. This should cover the majority of medicines prescribed in primary care and allow users to report adverse reactions.
• Commission research teams to review, develop and evaluate digital decision-support tools and work with GP IT system providers to ensure that these products support safe and appropriate prescribing. They should also ensure that digital systems and records make structured medication reviews a simple task.
• Work with stakeholders and system vendors to support the recording of indications within digital systems.

The review was welcomed by the government, which said it would now implement the recommendations. Health and social care secretary Sajid Javid said the review would have a “lasting impact on people’s lives and improve the way medicines are prescribed.” He went on: “With 15% of people taking five or more medicines a day, in some cases to deal with the side effects of another medicine, more needs to be done to listen to patients and help clinical teams tackle overprescribing.”