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When less is more: the challenge of polypharmacy
  1. Nina L Barnett1,
  2. Lelly Oboh2
  1. 1East and South East England Specialist Pharmacy Services and North West London Hospitals Trust, UK
  2. 2East and South East England Specialist Pharmacy Services and Guys and St Thomas’ NHS Community Health Services
  1. Correspondence to Nina L Barnett, Pharmacy Department, Northwick Park Hospital, Watford Road HA1 3UJ, UK; nina.barnett{at}


We know that in the UK, up to 50% of medicines in England are not taken as intended, and this has been demonstrated in the US. Studies have shown that there is a clear relationship between medication adherence and improved outcomes, and a recent report suggests that up to £500 m could be potentially saved if adherence was improved in five key health categories. Over the past 10 years, a number of comprehensive reports have been published which describe the many factors that affect medication adherence. There have been many attempts to predict non-adherence in order to allow clinicians to effectively identify patients who need support with medication adherence. However, the findings are inconsistent with regard to demographic, socioeconomic and clinical factors. Pharmacists are experienced in managing practical problems that patients may have about medicines. The evidence base for a behavioural approach to medicines adherence is growing and while all the interventions differ in their approach, the four Es have been suggested as overarching principles which can be applied to many of the interventions. In the UK, the structured approach of the funded New Medicines Service provides guidance to community pharmacists on undertaking discussion with patients, and can be used with the four Es to support adherence.

  • Evidence based medicine
  • GENERAL MEDICINE (see Internal Medicine)

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