Community pharmacists are well placed to have initial conversations with patients who are taking medications that are known to be high risk, medications that cause harm and combinations that can be flagged with the prescriber (see Scottish polypharmacy guidance). 

An example would be the combination of a diuretic, an ACE inhibitor and NSAID.

Another major area where interventions can be made is for medications that should not be taken long-term (e.g. proton pump inhibitors and painkillers). 

Community pharmacists are often the first port of call for advice on symptoms such as sickness and diarrhoea and are therefore well placed to advise patients on action that could be taken when they are ill. In polypharmacy guidance, this is referred to as ‘sick day rules’.

An example would be for an ill patient on metformin to stop the drug for the days when they have diarrhoea, vomiting or sickness. This would be to prevent potentially developing acute kidney injury.

Referral for a review

Many GP practices now employ pharmacists. Community pharmacists are well placed to identify patients in need of a more in-depth medication review and refer these people to their local practice pharmacist. 

Many community pharmacists also provide medications and advice to care homes. Pharmacists working in and with care homes are becoming more involved in long-term medication management and associated treatment reviews in discussion with care home staff, residents and their carers.