Polypharmacy

Audience

• All NHS Highland
• Primary and Secondary Care
• Adults and Children

'We are delighted to present the fourth edition of Polypharmacy Guidance: Appropriate Prescribing - Making medicines safe, effective and sustainable 2026-2029 which aims to provide guidance on preventing inappropriate polypharmacy at every stage of the person’s journey.

Updates to this edition include: 

• The 7-Steps process is a clear structure for both the initiation of new and the review of existing treatments, which places a greater emphasis on ‘what matters to the individual?’
• The Drug Efficacy (NNT) tables have been further refined and provide the 2 relative clinical efficacy of common interventions.
• Harm reduction can be targeted through the use of the Cumulative Toxicity and Anticholinergic Burden guidance. Both have been updated and the former of which has been revised and updated through a modified Delphi (clinical consensus) approach.
• The extensive set of National Polypharmacy Indicators have been further developed and prioritised by a clinical consensus approach. These support national progress and aid prioritisation of individuals for review.
• Alongside this, standardised Case Finding indicators have been incorporated into clinical decision support tools in GP IT systems that have Medicines and Healthcare products Regulatory Agency (MHRA) approval, to facilitate improvement and support clinical outcome monitoring. These can be found within the Scottish Therapeutics Utility (STU).
• The person-centred Manage Medicines app, which supports individuals, their families and carers in shared decision-making about their medicines, has been developed further and now contains PROMs (patient reported outcome measures). This allows the individual to prepare for these conversations by considering “what matters to me”. To support this there is also development of adherence visualisation.
• Updated and expanded Case Studies which use realistic scenarios that provide pragmatic advice on how to manage a range of commonly challenging situations
• Hot Topic reviews that look in depth at 8 areas of particular focus:
  • Anticholinergics
  • Falls Risk
  • Antipsychotics and Dementia
  • Stopping benzodiazapines and Z drugs
  • Management of constipation
  • Management of glycaemic control
  • Chronic Pain
  •  Medication in the frailest adults.

Addressing inappropriate  polypharmacy contributes to addressing the climate and sustainability strategy by both reducing the waste from the number of medicines unnecessarily prescribed and the reduction in carbon footprint from hospital admissions or primary care contacts due to medication-related harm.'