How can I effectively manage polypharmacy in patients with multiple chronic conditions?

Effective management of polypharmacy in patients with multiple chronic conditions involves a personalised, structured approach that takes into account the individual's overall health, treatment burden, and personal goals. Start by conducting a structured medication review to critically examine all prescribed, over-the-counter, and complementary medicines, assessing their safety, effectiveness, appropriateness, and alignment with national guidance. Engage the patient and, where appropriate, their family or carers in discussions about their medicines, addressing concerns, understanding, and preferences to reach an agreed management plan. Consider deprescribing or stopping medicines where there is no clear benefit or where the treatment burden outweighs the benefits, such as stopping bisphosphonates after 3 years if appropriate. Assess frailty and treatment burden to prioritise interventions and tailor care, using validated tools where possible. Coordinate care across services to ensure communication and continuity, assigning responsibility for care coordination. Develop and agree an individualised management plan that includes starting, stopping, or changing medicines and non-pharmacological treatments, prioritising healthcare appointments, and planning follow-up and review. This approach aims to improve quality of life by reducing adverse events, treatment burden, and unplanned care, while respecting the patient's values and health priorities.