References
Polypharmacy perspectives in general practice environments
Abstract
Practice nurses need to keep up-to-date with the latest prescribing guidelines, especially for patients taking multiple medications. Gerri Kaufman discusses some of the challenges facing polypharmacy and considers the roles of deprescription and medicines reviews
Polypharmacy refers to the use of multiple medicines. A combination of medicines can be appropriate and beneficial for the patient; however, polypharmacy can also be problematic where the risk of harm outweighs the benefits of treatment. Polypharmacy is associated with increasing age, the presence of multi-morbidities, a culture of single condition guideline-based prescribing, obesity and lower wealth. Managing polypharmacy is a challenge for prescribers working in general practice and primary care. Polypharmacy is associated with adverse outcomes, including adverse drug reactions, falls, increased length of stay in hospital, and mortality. Vigilance around the safer aspects of prescribing, undertaking structured medication reviews and deprescribing are considered important in addressing issues with polypharmacy, and enhancing the management of patients on multiple medicines. Comprehensive guidance is available on the medication review process and deprescribing; however, the process is time-consuming, complex and requires investment. The NHS Long Term Plan put forward proposals to increase investment in primary care services, which include addressing medication safety. Workforce shortages and funding cuts for continuing professional development are both perceived as barriers to its implementation. Both individual prescribers and the systems in which they work are accountable for improving safe medicine use in polypharmacy.
Medicines have made a significant contribution to the health of the population and their use is on the rise (Royal Pharmaceutical Society (RPS), 2019). This increase is escalating concerns about polypharmacy, which is a challenge for general practice and primary care (Guthrie et al, 2015; Swinglehurst and Fudge, 2017).
Polypharmacy is associated with increasing age, the presence of multi-morbidities, and a culture of single condition, guideline-based prescribing (Burt et al, 2018; Slater et al, 2018). Polypharmacy is also associated with obesity and lower wealth, and its prevalence is likely to become more pronounced as the obesity epidemic continues and the gap in UK health inequalities widens (Slater et al, 2018). The Scottish Government Polypharmacy Model of Care Group (2018) has highlighted the need to address polypharmacy management as a public health issue, because multi-morbidities affect a broader population than the older community alone. They pointed out that 29% of patients with multi-morbidities are under the age of 65 and come from the most deprived communities (Scottish Government Polypharmacy Model of Care Group, 2018).
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