Talking Meds - A PrescQIPP podcast

In this episode of Talking Meds we continue the series ‘Sensible prescribing in Older people with Jonathan and Lucy' with a discussion between Jonathan Underhill and Dr Lucy Pollock about the prescribing of statins.So we meet Mrs Evans, an 87 year old lady who lives with her daughter in a ‘granny flat’ annex of her house. She has several co-morbidites including type 2 diabetes, hypertension, heart failure with preserved ejection fraction and has recently had a stroke. Her daughter is concerned about her mum who she says ‘the sparkle has gone from her eyes’. Mrs Evans often looks at her daily handful of medicines and asks ‘what’s the point?Mrs Evans has recently been prescribed atorvastatin 80mg a day - in line with the guideline from NICE. Mrs Evan’s daughter asks Lucy - ‘are these new tablets worth my mum’s time?’ To try and help answer this, Jonathan and Lucy look at the icon arrays on the statins tab of GP Evidence where it shows how, out of 100 people like Mrs Evans who don't take a statin, around 29 will have a heart attack or stroke in the next 10 years. If all 100 take a statin, then 7 will be prevented from having a cardiovascular event but 22 will still have one. So the majority, 78, will not have a heart attack or stroke, but 71 wouldn’t have had one anyway without taking a statin!Explaining risks and benefits using numbers can often help some people - but not everyone. The important thing is to ask and find out 'what is it that really matters to you?'PrescQIPP resources mentioned in this episode:PrescQIPP Lipid modification e-learning course (pay per use)PrescQIPP Prescribing Mastery webinar 'Cholesterol management' Other resources mentioned in this episode:BBC Podcast with Rory Stewart - the long history of ignoranceCardiovascular disease: risk assessment and reduction, including lipid modification (NG238)Risk communication: NICE Shared Decision making guideline recommendations 1.4Drug and Therapeutics Bulletin - How to communicate evidence to patients by Baroness Alex FreemanA new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here

Join Prof. Anna Murphy, a respiratory pharmacy expert with over 25 years in the field, and Ravijyot Saggu, an honorary lecturer dedicated to sustainable care, as they discuss groundbreaking updates to asthma guidelines. They explore the integration of NICE, BTS, and SIGN recommendations, emphasizing a person-centered approach. Topics include new treatment protocols, challenges in asthma diagnosis, and the crucial role of pharmacists in patient care. Their insights on enhancing collaboration in asthma management are both enlightening and vital for improving health outcomes.

Lucy Pollock, a consultant geriatrician and author, shares her insights on sensible prescribing for older adults facing heart failure. She discusses the 'Four Pillars' approach to treatment, emphasizing the importance of tailoring care to patients' needs rather than rigidly following protocols. Through the case of Janet, an 86-year-old woman coping with loss and loneliness, they explore the significance of understanding patients' priorities and the power of empathetic communication in enhancing quality of life and care.

Neal Maskrey, a seasoned GP and author, shares insights from his book, 'Rebalancing Medicine.' He discusses the evolution of medical narratives, blending personal stories with historical contexts. The conversation dives into the complexities of healthcare systems and the vital role of empathy in patient interactions. Maskrey emphasizes the need for a patient-centered approach amidst resource challenges, advocating for quality of life over costly technologies. His reflections offer crucial guidance for future healthcare professionals and policymakers.

Dr. Lucy Pollock, a consultant geriatrician and author specializing in older people's care, joins Jonathan Underhill to discuss the concept of drug holidays, especially during the festive season. They explore when it’s appropriate to pause medications, enhancing life quality and reducing drug burden. Lucy shares insights on managing alcohol consumption safely while on medication, emphasizing moderation. The conversation also touches on aging and healthcare storytelling, advocating for patient-centered care and improved healthcare experiences.

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, talks to Hayley Berry about the update to the NICE Guideline on the identification and management of the menopause, published in November 2024. Hayley has a background in community pharmacy and general practice and now works for CPPE at the University of Manchester as a Lead learning development pharmacist. As a pharmacist independent prescriber, she works at a private menopause clinic and was a member of the NICE Menopause guideline development committee.Jonathan and Hayley discuss the important aspects of the update and touch on some of the somewhat controversial issues that surround this subject. The choice about whether to take HRT or not is a highly preference sensitive decision, where the values and preference of each woman needs to be taken into account. They discuss the various tools available to help facilitate those conversations, particularly the discussion tool published by NICE to accompany the guideline update, as well as the excellent GP Evidence website and the upcoming patient decision aid being developed by the Winton Centre.They also discuss the research recommendations within the guideline, highlighting how relatively poor the existing evidence base is for the management of the menopause.Resources mentioned in this episode include:NICE Guideline on Menopause: identification and management. NG 23 – updated November 2024Tools from NICE to communicate the benefits and risks of HRTGP Evidence has summarised the evidence on the benefits and risks of HRT for menopause.Winton Centre for Risk and Evidence Communication – watch this space for the upcoming menopause patient decision aidNICE CKS Menopause topic (excellent for a quick summary of the guidance)Useful related resources from PrescQIPP:PrescQIPP Bulletin 299. MenopausePrescQIPP Clinical Masterclass on 29th January 2025 on the NICE Menopause GuidelineA new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds on the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, continues the series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’. Today, Jonathan and Lucy talk about the identification AND sensible management of heart failure with preserved ejection fraction. They discuss how we need to have a different approach than that for heart failure where the ejection fraction is reduced by a significant amount. But that the key is to consider what matters most to people and tailor our approach accordingly. Its guidelines not tramlines!The importance of ‘sick day rules’ are also discussed – stopping medicines for a short period where volume depletion or a urinary tract infection (UTI) is present.We also meet Marjory, who has recently been started on dapagliflozin but is admitted to hospital with a raging UTI and delirium. The EMPORER study found that for every 100 people on a flozin, one of them would get a UTI due to the flozin. But this risk may be higher in older people as they are at higher risk of this happening in the first place than those included in the EMPORER study. Medicine is tricky eh?See the tab for HFPrEF in GP Evidence https://gpevidence.org/ to illustrate this with icon arrays.Resources mentioned in this episode include:P Moorhouse, K Rockwood. Frailty and its quantitative clinical evaluationNational Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribingNICE guideline [NG109]Published: 31 October 2018PrescQIPP bulletin 347. Chronic Heart FailurePrescQIPP e-learning. Chronic Heart Failure in Adults (pay per use)A new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds on the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill talks to Clare Howard, Clinical Lead for Medicines Optimisation at Health Innovation Wessex, about the development of the Repeat Prescribing Toolkit she led on behalf of the Royal Pharmaceutical Society and Royal College of General Practitioners. The toolkit was commissioned by NHS England in answer to recommendation 7 of  the National Overprescribing Review, to help practices improve the consistency of their repeat prescribing processes. There are 1.18 billion medicines prescribed and dispensed in Primary Care in England each year. While most people get their medicines without any issues, there are around 20-30,000 ‘probable avoidable’ harm incidents each year, of which around a quarter are related to medicines. Clare and Jonathan discuss the multiple ways this toolkit can help reduce the risk of these errors.The NHS is a complex system, and repeat prescribing is a ‘WICKED’ problem (difficult or impossible to fix) as it involves human to human interactions. Clare and Jonathan acknowledge that while you can’t ‘fix’ it and completely prevent any errors, having a structured approach can help reduce the risk of those errors and make for a more efficient process (and happier patients and healthcare staff!)Resources mentioned in this episode include:Repeat Prescribing Toolkit:https://www.rpharms.com/resources/repeat-prescribing-toolkitNational Polypharmacy Programme from Wessex Health Innovation Networkhttps://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacyGet details of upcoming ALS cohorts and book your place here. Useful related resources from PrescQIPP:The PrescQIPP 'Practice Medicines Coordinators' e-learning course is recommended as a training resource for prescription clerks in the RPS/RCGP Repeat Prescribing Toolkit.PrescQIPP Practice Medicines Coordinators e-learning course (Pay per use)PrescQIPP Bulletin 325: Empowering patients to manage their repeat prescriptionsPrescQIPP Bulletin 292: Repeat prescriptionsA new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, continues the series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’.Jonathan and Lucy discuss Brenda, an older lady who has become frail and has significant dementia that is affecting her ability to cope with everyday life and living. She has been taking aspirin, originally intended to reduce her risk of a further heart attack, but which hasn’t been thought about for a while. They discuss how clinicians are prone to overestimate benefits of medicines, but underestimate harms. The importance of finding out a patient’s (and their carer’s) expectations are key to sensible prescribing. Sometimes the tablets aren’t worth our precious older people taking them, as the harms may well outweigh the potentially small benefits.Resources mentioned in this episode include:GPs’ understanding of the benefits and harms of treatments for long-term conditions: an online survey. Julian Treadwell in British Journal of General Practice. https://bjgpopen.org/content/4/1/bjgpopen20X101016A brilliant resource to help illustrate likely benefits and harms for some commonly used medicines - GP Evidence https://gpevidence.org/PrescQIPP webinar recording. How well do GPs understand the benefits and harms of treatments for long term conditions?Dr Julian Treadwell.https://www.prescqipp.info/our-resources/clinical-webinars/how-well-do-gps-understand-the-benefits-and-harms-of-treatments-for-long-term-conditions/A new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here

Welcome to the latest episode of Talking Meds and the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, talks to Dr Mark Horowitz about how to safely stop antidepressants and the importance of tapering dose reduction slowly to reduce the risk of withdrawal symptoms.Dr Mark Horowitz  is a training psychiatrist and Visiting Lecturer in London, and  the lead author of the Maudsley Deprescribing Guidelines (see below). Mark co-authored the recent Royal College of Psychiatrists’ guidance on ‘Stopping Antidepressants’, and has been commissioned by Health Education England to prepare a teaching module on how to safely stop antidepressants for the NHS (coming soon!). Mark has experienced the difficulty of coming off psychiatric medications first hand which has informed much of his work.Useful sources referred to in this episode include:Dose response curves/Law of Mass action illustrated here (see figure 1)https://pharmaceutical-journal.com/article/ld/case-based-learning-safe-withdrawal-and-tapering-of-antidepressantsThe Maudsley Deprescribing Guidelines: Antidepressants, Benzodiazepines, Gabapentinoids and Z-drugshttps://www.wiley.com/en-gb/The+Maudsley+Deprescribing+Guidelines%3A+Antidepressants%2C+Benzodiazepines%2C+Gabapentinoids+and+Z-drugs-p-9781119823025RPS members can get free access to the Maudsley Deprescribing Guidelines here:https://www.vlebooks.com/Account/Logon/RPSMaudsley Prescribing GuidelinesThe Maudsley Prescribing Guidelines in Psychiatry eBook Register for an NHS England OpenAthens account.NICE guidelinesNICE guideline on depression in adults – see section 1.4.12 to 1.4.21 for information on stopping antidepressants.NICE guideline on medicines associated with dependence or withdrawal symptoms - further recommendations on withdrawing antidepressants.Clinical Knowledge Summary (CKS)NICE clinical knowledge summaA new episode of Talking Meds will be available every other Friday.If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.infoPrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals. The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you. Find out more about PrescQIPP here