Edinburgh Napier University

  As many as 50% of all patients with long-term conditions are using their medicines in a way that is not fully effective. This results in suboptimal treatment of their condition and attendance or admission to hospital. There is a significant level of inappropriate medicine prescribing which compounds this problem. In terms of emergency department attendances, it has been reported that as many as 28% of such attendances were related to medicines with 70% being preventable. Similarly, it has been found that medicine related visits accounted for 12.5% of attendances to hospital, the main causes being adverse drug reactions (ADRs) and nonadherence to medicines (33% and 19%, respectively). Worldwide, 3–6% of all hospital admissions are attributed to medicines, and 50% of these are said to be preventable.

Polypharmacy describes the concomitant use of two or more medicines and represents a growing global challenge attributable to aging populations with an increasing prevalence of multimorbidity. Polypharmacy can be appropriate but is problematic when the increased risk of harm from interactions between drugs and between drugs and diseases and the use of high-risk medications or if the burden of administering and monitoring medicines outweighs their plausible benefits.

This chapter will highlight programs that have been effective in reducing inappropriate polypharmacy, usually through medication review and deprescribing using change management to address barriers, culture, and the use of enablers. Effective programs include the pharmacist as part of the multidisciplinary team.

It provides a review of the available emerging evidence on interventions to address inappropriate polypharmacy, including published and gray literature. While more evidence is needed on the scale-up of research, programs that have been successful in addressing both clinical outcomes and economic benefit are discussed, including the crucial role that patients, healthcare professionals, and policy makers will need to take to have an impact on patient care. Tools that have been used to implement change such as guidelines, change management tools, and indicators to improve quality of prescribing will be discussed and shared.