Polypharmacy means many medicines and it becomes an issue for patients if they are prescribed medicines that are not or no longer needed. Polypharmacy increases a patient’s risk of hospital admission, as well as contributing to medicines waste and unnecessary cost to the NHS.

Older people are more likely to experience polypharmacy due to multimorbidities, but more and more people under the age of 65, such as those with advanced cancer and learning disabilities, are living with multimorbidities, so it’s important to be aware that the issue can affect more than just the elderly.

As well as multimorbidities, polypharmacy can be caused by:

• A lack of shared decisionmaking between healthcare teams and the patient
• Poor communication between multiple prescribers and not taking into account the clinical complexity of the patient
• Reflex prescribing – medicines being prescribed to manage unrecognised side effects of other medication.

Long-term polypharmacy can be a burden for patients and affect their quality of life, with 50 per cent of people on long-term medicines not taking them as intended. This can also lead to more unplanned hospital admissions and increased risk of experiencing adverse drug interactions.

Patients on multiple medicines might come to the pharmacy for a medicines use review (MUR) as a result of self-referral, a family member or friend expressing concern about them, or referral from their GP. Community pharmacy teams can also identify patients in need of a review during informal interactions and conversations in the pharmacy.

It’s important to adopt a patient-centred approach when identifying patients who have polypharmacy and recommending them for an MUR. This includes looking at the patient’s needs and preferences, rather than just the medicines they’re on, and including them in the decisionmaking process.

Screening criteria can be used to identify patients who are experiencing issues with polypharmacy. This could include questions regarding medicines access, adherence, day-to-day management and clinical issues.

When identifying patients who have problematic polypharmacy, it’s important to consider high-risk prescribing indicators. For instance, patients over the age of 75 who are prescribed an NSAID without gastro-protection, or other triggers such as a patient returning unusually large quantities of medicines.