Polypharmacy can be defined as the use of multiple medicines, often more than four or five, and commonly over ten. The number of patients taking multiple medicines is growing each year. By 2018 three million people in the UK will have a long term condition managed by polypharmacy(1).
Healthcare professionals have a joint responsibility to ensure that problematic polypharmacy is tackled effectively to achieve the best possible outcome for the patient while also ensuring patient safety remains paramount. A person taking 10 or more medicines is 300% more likely to be admitted to hospital(2).
How does polypharmacy arise? Is it simply irresponsible prescribing or more likely the result of a series events over time?
Clinicians have clear guidelines of best practice to follow often requiring multiple medicines to treat. However, patients aren’t simple and very often have multiple morbidities requiring further treatment regimes. This is when problems arise because instead of holistically looking at all the medications to decide which are really needed or if the additive effects of multiple medicines could be having adverse effects, more medicines are added.
Reflex prescribing is a common cause of polypharmacy. This is when an adverse drug reaction is mistakenly diagnosed as a new condition and new medicines given. In hindsight, the initial medication should have been reviewed and the dose altered or an alternative tried to establish if that removed the new symptoms the patient had been experiencing. This type of reflex prescribing can quickly add up to polypharmacy when really the patient only has the original condition.
Not involving patients in decisions about their care will lead to non-adherence and a disinterest in their treatment which in turn results in medicine waste. It’s important to talk to patients to establish what their goals are and what they want to achieve, as healthcare professionals we must take care not to assume that we know best. This will allow patients to raise concerns they may have at the initial point of prescribing which can result in a reduction of items prescribed.
The final cause of polypharmacy in many people, particularly the older generations, is transfer of care. Patients are discharged from hospital with on average 1.5 more items than they went in with(3), and 30 to 70% of patients have unintentional errors or changes to their prescriptions when moving between care settings(4,5). Primary care clinicians may feel inclined to keep the medications that have been added by the specialists but often the specialists are focussed on treating one condition and not looking at the patient’s care holistically. This is where GPs and community pharmacists can make a real difference to the patient’s experience.
Healthcare professionals must to work together to tackle the issues of polypharmacy, making sure to keep patients involved in the decisions about their care. Medication reviews need to be frequent and flexible to make allowances for changes and patient preferences. And with a joint effort we can start to tackle this growing epidemic.
- Department of Health. Long term conditions compendium of information. Third Edition, Crown copyright.
- Payne RA et al. Is polypharmacy always hazardous. A retrospective cohort analysis using linked electronic health records from primary and secondary care. British Journal of Clinical Pharmacology 2014;77: 1073-1082.
- Betteridge TM et al. Polypharmacy – we make it worse! A cross sectional study from an acute admissions unit. Internal Medicines Journal 2012; 42: 208-211.
- Picton C and Wright H. Keeping patients safe when they transfer between care providers -getting the medicines right. Royal Pharmaceutical Society. 2012.
- National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to ensure the best possible outcomes. [NG5]. 2015.