Growing numbers of people live with multi-morbidity. As patients’ lists of co-morbidities grow, so do the lists of their medications. Polypharmacy presents a significant challenge for both patients and clinicians. Polypharmacy can be appropriate, improving quality of life and life expectancy, but problematic, especially for patients living with frailty, and a growing burden. The task of trying to rationalise an extensive list of medications in a 10-minute appointment can seem like an impossible task. Guidance and support specifically aimed at trainees is limited. This article offers a starting point for GP trainees to stimulate their own exploration of this rapidly evolving subject.
Get full access to this article
View all access options for this article.
References
1.
Avery A, Barber N, Ghaleb M, et al. (2012) Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe study. Available at: www.gmc-uk.org/about/research/12996. asp (accessed 30 August 2019).
2.
AveryAJBellBG (2019) Rationalising medications through deprescribing. BMJ364: l570DOI: 10.1136/bmj.I570.
3.
BarberNDAlldredDPRaynorDK, et al.(2009) Care homes’ use of medicines study: Prevalence, causes and potential harm of medication errors in care homes for older people. BMJ Quality & Safety18(5): 341–346. DOI: 10.1136/qshc.2009.034231.
4.
BlochFThibaudMDuguéB, et al.(2010) Laxatives as a risk factor for iatrogenic falls in elderly subjects. Myth or reality? Drugs & Aging27(11): 895–901. DOI: 10.2165/11584280-000000000-00000.
5.
BoydKMurraySA (2010) Recognising and managing key transitions in end of life care. British Medical Journal341: c4863DOI: 10.1136/bmj.c4863.
6.
DenfordSFrostJDieppeP, et al.(2014) Individualisation of drug treatments for patients with long-term conditions: A review of concepts. BMJ Open4(3): e004172DOI: 10.1136/bmjopen-2013-004172.
GuthrieBMakubateB (2012) The rising tide of polypharmacy and potentially serious drug interactions 1995–2010: Repeated cross sectional analysis of dispensed prescribing in one region. Primary Health Care Research & Development13(S1): 45 SE.2 DOI: 10.1186/s12916-015-0322-7.
10.
HanlonPNichollBIJaniBD, et al.(2019) Examining patterns of multimorbidity, polypharmacy and risk of adverse drug reactions in chronic obstructive pulmonary disease: A cross-sectional UK Biobank study. BMJ Open8(1): e018404DOI: 10.1136/bmjopen-2017-018404.
11.
HeatonJBrittenNKrskaJ, et al.(2017) Person-centred medicines optimisation policy in England: An agenda for research on polypharmacy. Primary Health Care Research and Development18(1): 24–34. DOI: 10.1017/S1463423616000207.
12.
KatusiimeBCorlettSAKrskaJ (2018) Development and validation of a revised instrument to measure burden of long-term medicines use: The Living with Medicines Questionnaire version 3. Patient Related Outcome Measures Journal9: 155–168. DOI: 10.2147/PROM.S151143.
13.
KrskaJKatusiimeBCorlettSA (2018) Patient experiences of the burden of long-term medicines use and factors affecting burden: A cross-sectional survey. Health and Social Care in the Community26(6): 946–959. DOI: 10.1111/hsc.12624.
O’MahonyDO’SullivanDByrneS, et al.(2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing44(2): 213–218. DOI: 10.1093/ageing/afu145.
PageATCliffordRMPotterK, et al.(2016) The feasibility and effect of deprescribing in older adults on mortality and health: A systematic review and meta-analysis. British Journal of Clinical Pharmacy82: 583–623. DOI: 10.1111/bcp.12975 pmid: 27077231.
PootsAJJubrajBBarnettNL (2017) Education around deprescribing: ‘spread and embed’ the story so far. European Journal of Hospital Pharmacy24(1): 7–9. DOI: 10.1136/ejhpharm-2016-001153.
ReeveJBrittenNByngR, et al.(2018) Identifying enablers and barriers to individually tailored prescribing: A survey of healthcare professionals in the UK. BMC Family Practice19(1): 17DOI: 10.1186/s12875-017-0705-2.
25.
SzczepuraAWildDNelsonS (2011) Medication administration errors for older people in long-term residential care. BMC Geriatrics11: 82DOI: 10.1186/1471-2318-11-82.
