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Pharmacist review of GP patients drastically reduces sulfonylurea prescriptions

A medication review of over 600 elderly GP patients with diabetes has seen 40% completely stop being prescribed sulfonylureas.

The review, which forms part of NHS West Hampshire CCG’s ongoing drive to help GPs review frail patients receiving multiple medicines, resulted in 58% either stopping the drugs completely or reducing the dosage.

This comes after a major UK study found that switching diabetes patients to sulfonylurea increased their risk of heart attack and all-cause death.

In this latest trial carried out by NHS West Hampshire CCG last year, pharmacists used GP practices databases to identify 618 people aged 75 and over with diabetes, who were taking sulfonylureas and had HbA1c levels of less than 53mmol/mol.

It aimed to optimise prescribing and avoid hypoglycaemic episodes, ambulance callouts and acute hospital admissions.

The patients had their type two diabetes therapy reviewed, with their renal function checked and their concurrent comorbidities assessed.

This led to 255 people being taken off a sulfonylurea completely, while a further 102 patients had their dose reduced.

Treatment was continued in the remaining 261 people, although continuing reviews have been advised.

University Hospitals Southampton consultant pharmacist Philip Newland-Jones, who specialises in diabetes and supported the review, said: ‘Effective glycaemic control in type 2 diabetes reduces the risk of microvascular complications. However, the long-term benefits of tight glycaemic control in frail elderly patients are thought to be less than those for younger patients.

‘This intervention by CCG practice-based pharmacists is a perfect example of the clinical work that pharmacists undertake on a daily basis that has a direct beneficial impact on patient care.’

A spokesperson for the CCG added: ‘The CCG has previously supported GPs to identify and review patients on potentially problematic medicines including amiodarone, NSAIDs and quinine. Sulfonylureas have been identified as being problematic, particularly in the frail elderly patient, and as such were included as an intervention.

‘A number of practices in the CCG have additional support from the medicines optimisation team which enables appropriate patients to be reviewed by a clinical pharmacist.’

Another CCG recently funded a review of elderly patients who took multiple treatments a day, and found that over one-third of those could stop taking medication.


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