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Addressing the Challenge of Polypharmacy
- Alpana Mair1, Martin Wilson2, and Tobias Dreischulte3,4
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View Affiliations Hide AffiliationsAffiliations: 1Effective Prescribing and Therapeutics, Scottish Government, Edinburgh EH1 3DG, United Kingdom; email: [email protected] 2NHS Highland, Inverness IV2 3UJ, United Kingdom 3Quality, Safety, and Informatics Research Group, University of Dundee, Dundee DD1 4HN, United Kingdom 4Department of General Practice and Family Medicine, Ludwig Maximilian University Munich, 80366 Munich, Germany
- Vol. 60:661-681 (Volume publication date January 2020) https://doi.org/10.1146/annurev-pharmtox-010919-023508
- First published as a Review in Advance on October 07, 2019
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Copyright © 2020 by Annual Reviews. All rights reserved
Abstract
Polypharmacy describes the concomitant use of multiple 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 or between drugs and diseases or the burden of administering and monitoring medicines outweighs plausible benefits. Polypharmacy has a substantial economic impact in service demand and hospitalization as well as a detrimental impact on patients’ quality of life. Apart from causing avoidable harm, polypharmacy can also lead to therapeutic failure, with up to 50% of patients who take four or more medications not taking them as prescribed. Guidance is needed to support patients and clinicians in defining and achieving realistic goals of drug treatment, and system change is necessary to aid implementation. This article outlines lessons from two programs that aim to address these challenges: the Scottish polypharmacy guidance on realistic prescribing and the European Union SIMPATHY project.
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