Medication Burden in Multimorbidity

Why Does Multimorbidity Increase Medication Safety Risks?

Multimorbidity generally means living with at least two long-term health conditions. When clinical guidelines for each disease are applied independently, one person may receive numerous medicines, monitoring appointments and lifestyle instructions. The resulting plan can increase the risk of drug interactions, duplicated therapy and adverse effects, particularly when kidney function, liver function or frailty alters how medicines are processed.

Symptoms caused by treatment can also be mistaken for progression of disease. Dizziness, fatigue, confusion, bleeding or low blood pressure may prompt additional testing or prescribing unless clinicians consider medication-related causes. The World Health Organization's Medication Without Harm initiative identifies polypharmacy and transitions between care settings as important areas for improving medication safety.

What Should a Patient-Centred Medication Review Include?

The UK National Institute for Health and Care Excellence recommends a tailored multimorbidity approach for people whose treatment burden is high or whose medicines may cause significant harm. Its NG56 guideline specifically identifies people taking 10 or more regular medicines as a group in whom this approach should be considered, while noting that patients taking fewer medicines may also need it when risk is elevated.

A structured review should confirm why each medicine is being used, whether it remains effective, how treatments interact and whether the patient can manage the schedule. Clinicians should also ask about nonprescription products and supplements. Deprescribing may be appropriate when harms or burdens exceed likely benefits, but medicines should not be stopped abruptly without professional guidance because withdrawal effects or rapid disease worsening can occur.

How Can Physicians' Experiences Improve Multimorbidity Care?

The longitudinal qualitative study published in Scientific Reports examined physicians' experiences managing multimorbidity across the COVID-19 pandemic in Odisha. Qualitative research cannot establish how well a particular drug or care model works, but it can reveal how clinicians navigate uncertainty, competing priorities and disruptions in routine care over time.

The wider evidence supports moving from isolated disease management toward coordinated, person-centred care. Shared medication lists, reliable handovers, access to primary care and collaboration among physicians, nurses and pharmacists can reduce contradictory recommendations. Health systems also need enough consultation time for clinicians and patients to decide which outcomes matter most rather than pursuing every disease-specific target automatically.