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Managing polypharmacy – Transporting research into practice

Working as an academic GP for the past 3 years has been interesting and rewarding, and at times frustrating.

Being directly involved with projects that are trying to help change the way that primary care currently works has given me motivation and a sense of professional purpose that it was hard to find from working in a solely patient facing role. As a trainee GP and then First5 I was all too aware of the increasingly challenging environment that is primary care, and was concerned to see how more experienced colleagues were finding it harder to cope with the demands of the system. So maybe it is the system that needs to change I hear you cry. Not a fast and easy solution for such a short question, and was it even possible for me to try and be part of that change?

I started to realise that the evidence for change was there, and that we could make it possible. My frustration grew when I saw increasingly relevant research from the academic teams taking such a long time to have any influence on clinical practice. This is to an extent understandable; the necessary rigours of thorough research, peer review processes, and the need for bodies of evidence to influence policy. It all takes time. But then I saw my role as a clinical academic to help spread the message of important research in a relatively quick way that helps clinicians change their practice.

Earlier this year the TAILOR medication synthesis was published. It delivered a comprehensive literature review examining what is known about deprescribing for patients with polypharmacy and how clinicians could try to achieve such a complex and challenging goal with their patients. A large team of experienced researchers spent hundreds of hours applying research methods I had never before heard of to deliver the vitally important understanding and reassurance to prescribers. Deprescribing is safe, effective and acceptable for clinicians. Furthermore, there is no single best approach to this, which is a liberating concept. It tells us not only is deprescribing something we should be doing but we can find our own structured ways to implement it locally. It doesn’t invite a free for all or encourage reckless medicines management. Instead TAILOR highlights the need to personalise medication regimes and encourages clinicians to feel confident working outside of guidelines where appropriate, and to collaborate with colleagues across our expanding MDT to deliver this in a way that suits our local populations. I excitedly shared this with colleagues, only to find none had heard of TAILOR outside of academic circles. Again, the frustration of the delays between academia and practice.

Then Joanne Reeve offered me the chance to work with Clare Fozard in translating TAILOR into a bitesize educational resource. It seemed like the perfect opportunity to try and break down some of the barriers preventing GPs from accessing the messages from TAILOR. Indeed it has been another example of why clinicians working in research can directly improve the accessibility of up to date evidence based information that can both influence practice and improve patient care. My own clinical practice has changed, and I feel the care I give to polypharmacy patients has improved. Our hope is that TAILOR and the DExTruS model of care it created will inspire changes in practice across the NHS and wider afield. I challenge you to try the modules for yourself, access the TAILOR report, and drive that change wherever you are.

James Bennett


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