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Polypharmacy management programmes: the SIMPATHY Project

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Owing to advances in pharmacotherapy, older people are increasingly likely to be prescribed multiple medicines. Prescribing is largely based on single-disease evidence-based guidance, which does not generally take account of multimorbidity, which is now the norm in those over 65 years of age.1 Consequently, patients are prescribed several medicines recommended by disease-specific guidelines, which is potentially harmful for this specific population and challenging for them to manage. Inappropriate polypharmacy and medication non-adherence are two key inter-related problems in elderly multimorbid patients, with negative effects on health outcomes. Multimorbidity is associated with increased use of healthcare services (twice as high as non-multimorbid) and hospitalisation (three times higher).2

‘Polypharmacy’, the prescribing of multiple medicines, has been described as one of the most pressing prescribing challenges.3 Among Scottish patients with two clinical conditions, 20.8% were receiving four to nine medicines, and 10.1% were receiving 10 or more medicines.4 Polypharmacy increases the likelihood of adverse effects, impacting significantly on health outcomes and healthcare resources.5 Notably, most adverse effects are preventable through appropriate medicine selection, monitoring and review.6 Such effects in older people may arise from many inter-related factors including: age-related physiological changes (eg, reduced renal and hepatic function); multimorbidities; prescribing of multiple medicines; and confusion over medicine taking. While, traditionally, polypharmacy has been described as prescribing of four or five medicines, it has been suggested that, given the emphasis on evidence-based practice, there should be a change in focus from inappropriate polypharmacy (inappropriate prescribing of too many medicines) to optimal polypharmacy (appropriate prescribing of many medicines).7 It is commonly accepted among healthcare providers that polypharmacy is an issue. However, an agreed concept and definition of polypharmacy does not exist.

A person with multiple morbidities usually requires multiple medicines to control his/her conditions. Some medical conditions, such as cardiovascular …

Correspondence to Alpana Mair, Healthcare Quality and Strategy Directorate, Scottish Government, Edinburgh EH1 3DG UK; Alpana.Mair{at}gov.scot

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