Who should be targeted for review?

There has been a comprehensive review of the case finding criteria which identifies individuals who may benefit the most from a polypharmacy review. In the previous version of this guidance, these criteria were based on age, residency in a care home, number of repeat medicines prescribed and Scottish Patients at Risk of Readmission and Admission (SPARRA) score of 40-60%. This guidance recommends the use of the Rockwood Clinical Frailty Scale⁹⁴ to determine frailty and prioritise these individuals for review.

Trial evidence demonstrates the importance and impact of targeting those with high-risk prescribing.^{29,35,36,37,39,41,42,95} Holistic face-to-face reviews reduced the risk for these individuals and demonstrated a reduction in hospital admissions for acute kidney injury. The success of this approach has been used by the Data and Indicator sub-group and the guidance development group to consider a wider range of Case Finding indicators to target those on high-risk medications. These indicators have undergone peer review.

Another important area that the guidance development group considered was the effect of deprivation on rates of polypharmacy. The review of polypharmacy prescribing data (10 or more medicines including a high-risk medicine) by deprivation demonstrates that multimorbidity, and its associated problems, presents 10 to 15 years earlier in more deprived communities.

 

The following revised case finding criteria are recommended to prioritise individuals for a polypharmacy medication review:

A.  Prescribed 10 or more medicines with a high-risk medication (this will identify those from deprived communities where the average age is lower when taking 10 or more medications) 
B.  Adults aged 50 years and older and resident in a care home, regardless of the number of medicines prescribed
C.  Adults aged over 65 years: prioritising those living with frailty or anyone over 75 years
D.  Adults of any age, approaching the end of their life or receiving palliative care 
E.  Those receiving care at home or hospital at home
F.   Those on high-risk medication (as defined by the Case Finding indicators, regardless of the number of medicines taken