Article of the month March 2017

Medication Management – Practical Support Options for People Needing Polypharmacy

Dr Kevin Doughty



The role played by medication in helping people to recover from illness, injury or surgery is well-established. In the case of acute illnesses, the appropriate choice of medications can quickly overcome the symptoms and help to defeat the disease resulting in a cure. However, many chronic diseases from diabetes through to arthritis cannot yet be cured in most cases, and certainly not through medication alone. Medication is needed to manage the symptoms, but needs to be taken for many years. This raises the possibility (or perhaps probability) that adherence to the prescribed medication therapy will decline over time, limiting control of symptoms. Indeed, if the decline in health over subsequent years is slow, people may not associate cause with effect.

Today, about 10 million people in the UK are aged 65 or older. The number is likely to double within 35 years as the total population increases and as life expectancy continues to rise. However, because many types of chronic disease are the result of lifestyle choices, including the effects of smoking, alcohol, obesity and a lack of exercise, more than half this population will suffer from not a single disorder but from multiple comorbidities. Each disease may require specific medications, resulting in a need for polypharmacy as shown in Figure 1 with nearly 3 in 5 men and women aged over 85 requiring 5 or more different medications every day. Managing these prescriptions is a significant problem, and an issue that leads to poor outcomes, and health and social care system inefficiencies.

Poor concordance with physician instructions, and more general public health advice, are known to be the cause of many chronic diseases. This is particularly a problem in the developed world where the ability to make informed choices is high on the priorities for consumers who can be tempted by ease of access to fast foods and who have moved into sedentary occupations due to the decline in heavy industry and more labour-intensive jobs. But poor adherence to medication regimes is a problem throughout the world, and is linked to many social-economic and cultural factors. Technology and digital healthcare strategies can play a big role in improving adherence. The devices and systems that are available are described in this article.

Full article can be found here