Policy, medical training and clinical practice have failed to adapt to a significant increase in the number of patients taking multiple prescription drugs, according to a new report on taking numerous prescription drugs (polypharmacy) and medicines optimization by The King’s Fund.
Estimates suggest from 1995 to 2010 the number of patients taking 10 or more medicines tripled, reflecting a large increase in the number of people with complex, or several, long-term conditions. This is largely driven by an aging and increasingly frail population, but also by increasing use of multiple interventions. While in the past, polypharmacy often has been seen as something to be avoided, the report shows that taking an evidence-based approach to polypharmacy should improve outcomes for many people.
However, with most research and health systems based on single-disease frameworks, policy, medical training and clinical practice often have not adapted to provide ‘appropriate polypharmacy’—optimizing the use of multiple medicines and prescribing them according to best evidence. The report suggests for polypharmacy to be used more effectively there must be:
better training for doctors in managing complex multi-morbidity and in polypharmacy
more research set in the context of using treatments where people have several diseases, rather than selecting subjects who have single conditions
national guidelines for multi-morbidity to match those for single conditions
improved systems, particularly for GPs, to flag problematic polypharmacy
regular reviews of patients’ medication and a willingness to consider stopping medication, particularly in cases of limited life expectancy
changes in systems of medical care to move away from increased specialization toward a focus on multi-morbidity.
The report says polypharmacy must be better understood and defined, and accompanied by more engagement with patients to ensure medicines are taken in the way prescribers intend. This may require compromise between prescribers and patients to ensure patients feel confident in what they are taking and situations in which medicines go unused or wasted are avoided.
Integrated care now is widely accepted as the way to care for people living with multiple, complex, long-term conditions. Appropriate polypharmacy, or medicines optimization, similarly must be accepted as one of the ways in which more coordinated care can be delivered.
