Establishing a service to tackle problematic polypharmacy

Introduction: Polypharmacy is increasingly common and can increase the risk of adverse drug reactions (ADRs), accounting for a significant proportion of hospital admissions. It may also impair functional status and quality of life. Current efforts to improve polypharmacy take place largely in primary care, but there may be a role for increased support from medicines specialists in the secondary care setting.

Methods: We developed a pilot polypharmacy clinic in secondary care, led by clinical pharmacologists and pharmacists. Medicines were deprescribed as appropriate, based on clinical need and symptoms suspected of being ADRs. An ADR symptom burden was recorded pre- and post-intervention to identify any clinical changes following deprescribing.

Results: Twenty-four individuals were reviewed. The total number of medicines prescribed to each patient was reduced by a median of 4 (interquartile range (IQR) 2-5), resulting in annual savings in discontinued medicines of £4,957.44. The ADR burden fell from a median of 15 (IQR 14-17) to a median of 7 (IQR 4-11).

Conclusion: Our pilot clinic reviewed a small number of patients, but demonstrated the potential of such a service to offer both clinical improvements and cost savings. This service could be extended, integrated and sustained to improve care for people taking multiple medicines.