AVOIDING HARM: Tackling Problematic Polypharmacy through strengthening
Expert Generalist Practice
Abstract
Problematic polypharmacy is a growing challenge. Medication that is
intended to improve patients’ health and wellbeing is instead becoming
part of the problem. The way we practice medicine has become one of the
drivers for the problems. Dealing with the challenge will need us to
think differently about how we do clinical care. A 2013 Kings Fund
report stated that tackling problematic polypharmacy requires us to
actively build a principle of ‘compromise’ in to the way we use
medicines. There are implications for how we consult and make decisions
with patients, in how we design health practice and systems to support
that decision making, and in our understanding of the process of
research – how we generate the knowledge that informs practice. This
review considers the current state of play in all three areas and
identifies some of the work still need to do in order to generate the
practice-based evidence needed to tackle this most challenging problem.
Finding a way to redesign practice to address problematic polypharmacy
could offer a template for tackling other related complex issues facing
medical practice such as multimorbidity, chronic pain and complex mental
health.