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Addressing the Polypharmacy Challenge in Older People

The Polypharmacy Challenge Blog


Tackling Polypharmacy and Multimorbidity: Reflections on SAPC 2017

I have just returned from the annual scientific meeting of the Society for Academic Primary Care (SAPC), which was held at Warwick University last week. The central concerns of the APOLLO-MM project - multimorbidity and polypharmacy – featured prominently in this year’s meeting. This may seem unsurprising given that care of patients with multimorbidity is very much the ‘norm’ for the generalist medical practitioner. But it was encouraging to see an increasing emphasis on how to account for the complexity of multimorbidity in research contexts, and there is certainly a growing army of researchers trying to tackle ‘inappropriate’ polypharmacy.

One thing that became clear as I moved from presentation to presentation about polypharmacy is just how ‘baggy’ some of our definitions are. Researchers use a range of cut-off points to define polypharmacy (4+, 5+, 10+, 15+ medicines). They do so whilst acknowledging that definitions based on numbers alone are crude and inadequate, as these measures conceal crucial issues such as: the poor alignment between numbers of drugs prescribed, dispensed and consumed; the contribution of non-prescribed medicines to the medicines count; and the relative complexity of different medicines regimens to the individual patient. The terms ‘appropriate’ and ‘inappropriate’ which are frequent qualifiers of the ‘polypharmacy’ concept are widely used but beg further questions such as ‘appropriate to whom?’ and “appropriate for what purpose or with what in mind?” and cause us to stop and wonder how fixed and certain are these notions of appropriateness.
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