Polypharmacy prescribing guidance - draft: consultation

Introduction

The care of people with multimorbidity is one of the greatest challenges now faced by the health service. Care of adults with multiple medical conditions is often overly complex and rarely person-centred. This leads to poor health outcomes, unsustainable levels of expenditure and avoidable environmental damage, all of which disproportionately affects the most vulnerable in society. Medication is the single most common healthcare intervention and generates the third highest cost of health expenditure. A core element of care is the management of multiple medications (usually to manage multiple morbidity), known as polypharmacy.

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 vast majority of medical research, guidelines and contractual agreements have focussed on single targets for single disease states, whereas in reality most people have multimorbidities, requiring multiple treatments.

The resulting polypharmacy (use of multiple medicines) can be appropriate or inappropriate. Polypharmacy becomes inappropriate when the medication risks begin to outweigh the benefits for an individual, and this is the important area to consider rather than the number of medicines an individual is taking alone. The aim of addressing this is to identify those at greatest risk of harm and to agree a medication regimen that is tailored to their changing needs and expectations, so that the use of medicines is safe and person-centred. Although research in this area is limited, this guidance is based on best evidence to date from a review of current literature and has been developed to support both individuals and healthcare providers.

An important principle in improving the care of those with multimorbidity is to ensure an integrated care approach to health and social care services. This can help address medication systems, processes and procedures that support improved outcomes for people by helping reduce errors that result from disjointed ways of working.

This Prescribing Guide is intended to support clinicians and shared decision-making for people taking multiple medications in the most appropriate use of medicines, whilst applying the principles of value-based healthcare and realistic medicine.

This consultation provides an opportunity for all interested parties to comment on the draft guidance.

We will be holding a virtual consultation event during the consultation period and you can register your interest in attending by emailing EPandT@gov.scot.