Multi-morbidity and polypharmacy (that’s taking four or more medicines)
Taken from NICE Key Therapeutic Topics pages 5-10.
- People with multiple illnesses are often prescribed multiple medicines, with new medicines being added to counter side-effects of others. The actual benefits of doing this are hard to ascertain.
Taking multiple medicines involves increased risks.
- Everyone with multiple illnesses should receive a holistic person-centred review of their medicines and share in the decision making of what they take. (My view takes this further. I’d say ‘be given the option to lead on the decision making of what they take’).
- Polypharmacy (taking four or more medicines) can be divided into two categories. Appropriate polypharmacy, where the benefits and disadvantages have been fully evaluated together. Problematic polypharmacy, where this hasn’t been done and the benefits of the medicines are not realised, sometimes to the extent that they are making the person worse.
- There are some useful tools which can be used to help evaluate appropriateness of medicines in individuals (described in the document). Additionally I’d add that motivational interviewing techniques and time to build trust of the patients are also vital.
- Intentional non-adherence can be overcome in a trusting clinician patient relationship, which usually happens over time.
#jargonbuster ‘intentional non-adherence’ = not telling clinical staff what you are actually taking and/or not taking.
More on the NICE Key Therapeutics Document here:
Personal views of Steve Turner RGN; RMN; Ba (Hons); P.G. Dip Ed; MIHM
Steve is a nurse prescriber and NICE Medicines and Prescribing Programme Associate.
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For part one of this blog ‘Medicines are overused’ click on the image below: