Study aims to tackle overprescribing across England

A £2.4 million study is underway to reduce the amount of unnecessary or inappropriate medications prescribed to older patients.

The CHARMER (Comprehensive Geriatrician-led Medication Review) study aims to respond to the UK Government’s 2021 National Overprescribing Review which highlights the need to stop unnecessary or inappropriate medicines. 

Currently half of the older population are prescribed medicines that may pose safety risks. In addition, CHARMER’s research found that less than 1% of medicines are stopped during hospital stays.

The largest hospital trial of its kind internationally, CHARMER will involve around 100 hospital doctors and pharmacists across 24 hospitals, aiming to enhance the care of 20,000 older inpatients. It will focus on “proactive deprescribing” with the aim to empower hospital doctors and pharmacists to identify and discontinue unnecessary or inappropriate medications in those aged 65 or over before they cause harm.

The trial starts on 1 February 2024 and will run until Summer 2025.

Professor Debi Bhattacharya from the University of Leicester’s School of Healthcare is leading the CHARMER study, which has been developed in collaboration with healthcare professionals and patients.  

Professor Bhattacharya said: “Our aim is to improve the quality of life for older people by ensuring that they are only prescribed the medicines that are right for them. This is achieved by supporting hospital staff to consider potential future problems from the persons’ prescribed medicines and address them before they arise.”

Financial implications of overprescribing are significant – the NHS spends more than £18 billion annually on medications with a yearly increase of around 5%. Reducing this would not only lower the NHS drugs bill substantially, but should also prevent costly hospital readmissions related to medication issues.

Co-leading the trial are Professor David Wright (University of Leicester, School of Healthcare) and Professor David Alldred (University of Leeds, School of Healthcare) working with Norwich Clinical Trials Unit at the University of East Anglia.

Professor Wright said: “We know that taking more medicines increases the likelihood of medication errors and reduces the likelihood of patients taking their medicines as expected. CHARMER provides a good example of how multi-professional working can significantly improve patient care by addressing this problem.”

Professor Alldred added: “Taking unnecessary medicines can cause adverse effects and a hospital admission is an ideal opportunity for older people to have their medicines reviewed by specialist teams. Geriatricians and pharmacists will work together to identify and safely stop medicines where the risks outweigh the benefits, with the goal of improving the lives of older people.”

To learn more about the CHARMER trial visit charmerstudy.org.

Hospitals taking part include: 

• Royal Bolton Hospital, Bolton NHS Foundation Trust
• The Royal Oldham Hospital
• Royal United Hospitals Bath NHS Foundation Trust
• University Hospitals of Leicester NHS Trust
• The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust
• Lincoln County Hospital
• Hull University Teaching Hospitals NHS Trust
• University Hospital Southampton
• East Lancashire Hospitals NHS Trust
• Portsmouth Hospitals University NHS Trust
• Warrington and Halton Teaching Hospitals NHS Foundation Trust
• University Hospitals Plymouth NHS Trust (Derriford)
• Nottingham University Hospitals NHS Trust
• Royal Liverpool Hospital 
• Leeds Teaching Hospitals NHS Trust
• Sherwood Forest Hospitals NHS Foundation Trust
• Royal Free London NHS Foundation Trust (Barnet Hospital)