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Primary care pharmacists should carry out “at least” annual structured medication reviews with all patients with polypharmacy or taking high-risk medicines, according to updated guidance from the Scottish government.
The guidance also says pharmacists should consider home visits for house-bound individuals to reduce the potential for accumulation of medicines.
The fourth edition of ‘Polypharmacy guidance: appropriate prescribing, making medicines safe, effective and sustainable 2026/2029’ was published on 2 March 2026 and replaces guidance published in 2018.
In a joint introduction to the guidance co-signed by other clinicians, Alison Strath, chief pharmaceutical officer for Scotland, said: “There is a need to address polypharmacy management as a public health issue.
“Multimorbidity does not just affect the older adult. For example, 29% of people with multimorbidity are under the age of 65 years and disproportionally come from the most deprived communities.”
The updated guidance includes a greater emphasis on shared decision-making, with further development of the National Polypharmacy Indicators. It has also expanded the existing ‘Hot topics’ and ‘Case studies’ sections.
The guidance adds that case-finding indicators, which can identify patients at most risk of harm, have been incorporated into clinical decision support tools in GP IT systems that have Medicines and Healthcare products Regulatory Agency approval.
In its response to the government consultation on the draft guidelines, submitted in September 2025, the Royal Pharmaceutical Society in Scotland said: “We congratulate the team on the development of an approved medical device for incorporating the indicators into GP systems.
“This is a significant step forward in supporting data-driven identification of patients for review and should be highlighted as a key enabler of practice change.”
Read more: Polypharmacy and deprescribing in older people
