It is important to be aware of the factors that can cause polypharmacy so that you can recognise them as they occur and think of possible solutions.

Lack of shared decision-making

If patients are not involved in decisions about their medicines, there is a risk that what is prescribed may not match their preferences or expectations. This can lead to issues with nonadherence. Applying a patientcentred approach to the consultation provides the patient with an opportunity to voice concerns when a medicine is started and is key to minimising polypharmacy.

Multimorbidity

Treatment guidelines for single diseases recommend the use of a variety of evidence-based medicine treatments. While in many instances these are appropriate, there may be a mismatch between prescribing guidelines for specific medical conditions and the clinical complexity of individual patients.

In particular this may be true for patients who have multimorbidity, frailty, a dominant condition (for example, dementia) or may be approaching the end of their lives. In these situations, the sum of evidence-based recommendations may not be rational.

In addition, there may be many prescribers looking after one patient. Specialists are likely to be prescribing in their own area of expertise, but perhaps not managing the patient’s medicines as a whole, and GPs may be reluctant to review medicines that have been started in secondary care by specialists. A lack of clear documentation can exacerbate this problem, leaving ambiguity over the indication for medicines or direction for when medicines should be reviewed or stopped.