Review finds limited evidence of problematic polypharmacy in the UK

Evidence of the extent of problematic pharmacy in the UK, and the interventions needed to address it, is limited, according to a rapid review published in the British Journal of Clinical Pharmacology
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The review, commissioned by the Department of Health and Social Care, also found that there was “no consensus” on the definition of polypharmacy and “no evidence” of clinically relevant patient outcomes associated with reducing problematic polypharmacy.

In 2018, Matt Hancock, the secretary of state for health, commissioned the Short Life Working Group on Overprescribing to conduct a review into overprescribing in the NHS.

The authors included nine systematic reviews across ten publications; three considered the burden of problematic polypharmacy; six looked at interventions to reduce problematic pharmacy; and one analysed efficient handover between primary and secondary care to reduce problematic polypharmacy. All reviews were international, but most included some UK studies.

They concluded that the prevalence of polypharmacy in people living in long-term care facilities was high and associated with a greater mortality risk, although the link was unlikely to be causal.

They also found that interventions to reduce problematic polypharmacy were effective, but that there was no evidence on clinically relevant patient outcomes. They found some evidence that medicine reconciliation activities reduced medication discrepancies at care transitions, but the evidence was of low certainty.

Overall, they said there was “little reliable information” on the extent of problematic polypharmacy in the UK, what interventions were the most effective and the cost-effectiveness of these interventions in a UK setting.

Lelly Oboh, a consultant pharmacist for older people at Guy’s and St Thomas’ Hospital and the NHS Specialist Pharmacy Service, said that rather than defining polypharmacy by the number of medicines a person is taking, it was more useful to define polypharmacy as either “appropriate” or “problematic”.

She added that most care home residents — especially those classified as severely frail — have a short life span of usually 12–18 months, so reducing polypharmacy was not just about reducing the obvious primary and secondary outcomes of mortality and morbidity, as are often listed in drug trials, but reducing adverse effects and improving function.

“[We need to look at] quality of life, independence, mobility, pain, not feeling drowsy, falls and the impact of reduced pill burden on daily activities and carer experience,” she said.

“We need to rethink how we conduct research and measure patient-related outcomes — perhaps using complex research methodologies and more qualitative methods that include patient/carer feedback.”