Decisions about medications and the outcomes of any review should be made and communicated in partnership with the patient. Some patients may be reluctant to stop medications that they have previously been told they needed to take for life, especially if a specialist has initiated treatment. 

A common reason for stopping medications is because the evidence has changed or the patient is no longer able to take the medication and so obviously will not receive any benefits. There are shared decision-making tools for patients in a polypharmacy app based on the Scottish Government’s national guidance, so that they can consider benefits and harms when making decisions about medicines taking. 

Any medication changes should be transcribed to the patient’s repeat prescription record and the outcomes shared with his or her community pharmacist. This allows the pharmacist to reinforce the outcome of any polypharmacy review. 

The role of community pharmacists in helping to prevent the inadvertent restarting of medicines that have been stopped is key and depends on effective communication between surgery and pharmacy.

Polypharmacy reflective exercise

Anne Walker is 45 years old and lives alone but receives support in her home. She is overweight and has severe COPD. She is experiencing frequent exacerbations and has had monthly admissions to hospital for the past eight months. She has been a heavy smoker since she was 13 years old. 

Anne struggles to walk 100 metres without getting breathless and complains of pain from osteoarthritis. She has been prescribed pregabalin and paracetamol. After her last discharge appointment from hospital, she was prescribed standby antibiotics and steroids for exacerbations. Her routine blood tests indicated a slightly high cholesterol value, but her blood pressure was in the normal range. She needs long-term oxygen. 

Anne is managed in the community by a multidisciplinary team. She complains of breathlessness and pain, and asks what could be done to manage this and whether she needs a cholesterol tablet. She also tells you her breathlessness is becoming more problematic and asks whether she could have the codeine she was given in hospital. The discharge note to her GP did not mention any pain management. 

How would you handle this scenario? Consider the '7-Step' approach, starting out with "What matters to the patient?" What might be the outcome of such a review conducted for Anne?