Causes of inappropriate polypharmacy

Poor co-ordination of care increases the likelihood of polypharmacy and medication-related harm. For instance, people with multimorbidity often receive care from multiple prescribers and have complex medication regimen.¹⁷ This can result in communication breakdown between the different prescribers and healthcare professionals, and fragmentation of care.^17,18 There may be a reluctance to alter medication initiated by another prescriber across the interfaces of care, e.g. during a hospital admission or initiated by a specialist.¹⁹ This highlights that medication review is a dynamic process and healthcare professionals need to be empowered to re-assess the appropriateness of medication at all stages of the individual’s journey. This will need cultural change to address patient safety and improved communication across all care settings.¹⁹

Primary care prescribers can also feel that they are not empowered to alter medication commenced in another part of the health service, such as during a hospital admission or in a specialist clinic. Prescribers reviewing adults with multiple conditions need to be trained and empowered to review decisions throughout an individual’s journey taking into account factors that may not have been present, or taken account of, at the time of initial prescription. This requires improved communication between care settings and movement across care transitions can present an opportunity to identify and reduce inappropriate polypharmacy.^20,21