Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review

Area of Science:

• Gerontology
• Primary Care Medicine
• Clinical Pharmacy

Background:

• Polypharmacy and multimorbidity present growing healthcare challenges.
• Existing interventions have not consistently improved patient health outcomes.
• Ineffective patient targeting may be a key limitation.

Purpose of the Study:

• To review how patients with polypharmacy are targeted for interventions.
• To understand definitions of polypharmacy.
• To identify methods for targeting problematic polypharmacy in primary care.

Main Methods:

• A scoping review was conducted following Joanna Briggs Institute guidelines.
• Searches covered major databases (Medline, Embase, CINAHL, Cochrane) and clinical trial registries from 2004-2024.
• Included studies focused on problematic polypharmacy in multimorbidity within primary care, encompassing diverse evidence types.

Main Results:

• 157 articles were included in the review.
• Patient targeting often uses simple medication counts, ignoring clinical appropriateness and patient history.
• Current methods fail to identify all patients needing intervention due to inconsistencies and neglect of multimorbidity.

Conclusions:

• More effective strategies are needed to target patients experiencing polypharmacy.
• Interventions should incorporate patient perspectives, individual factors, and clinical appropriateness.
• Developing a standardized measure for problematic polypharmacy, adjusted for multimorbidity, is recommended.