Appropriate polypharmacy should be considered at every point of initiation of a new treatment for a patient and when a patient moves across different care settings. Community pharmacists may not have access to information about why a medicine is prescribed and whether a patient’s medicines are achieving their therapeutic objectives.

However, a pharmacist might be the only person who sees the full picture to identify potentially inappropriate polypharmacy in terms of possible ADRs and patient adherence (or not) to treatment. Community pharmacists are an essential part of the health and care system. Feeding this information back to either a practice pharmacist or the patient’s GP will help to improve outcomes.

The risk of harm is generally higher in older people with multimorbidities than in younger patients due to the former’s reduced ability to clear drugs (e.g. due to renal and/or hepatic impairment) and increased vulnerability to drugs’ adverse effects (due to general frailty and drug-drug and drug-disease interactions) and medication burden.

However, the increased risk of harm is not always offset by increased benefits and for many preventive medicines such benefits may never be realised due to shortened life expectancy.

SIMPATHY trial and the '7-Steps' approach

The SIMPATHY research project has been running for several years in a number of different countries. It aims to reduce inappropriate polypharmacy, which contributes to around 4 per cent of avoidable costs in healthcare, equating to an expenditure of £14bn worldwide. 

As mentioned previously, up to 11 per cent of unplanned hospital admissions in the UK are attributable to mostly avoidable harm from medicines, and of these, over 70 per cent are in elderly patients on multiple medicines. If these figures were extrapolated across Europe, 8.6 million unplanned admissions each year would be attributable to medicines, of which half would be preventable (SIMPATHY 2017).

There are significant opportunities to reduce this burden by timely and effective interventions and the Royal Pharmaceutical Society’s polypharmacy report highlights how pharmacists can make a difference.