Polypharmacy: When Is a Medication Review Needed?

Why can multiple chronic conditions complicate medication safety?

Researchers interviewed physicians in Odisha across three pandemic waves, beginning with 23 participants in June 2020; 18 participated in August 2021 and 16 in January 2022. Doctors described fewer specialist referrals and difficulties coordinating treatment across conditions. Published in 2024, the qualitative study examined clinical experiences; it did not test medication reviews or measure whether they prevented harm. Its findings nevertheless illustrate why a shared treatment plan matters when several clinicians are involved. [Scientific Reports study](https://www.nature.com/articles/s41598-024-60473-0)

Polypharmacy means using multiple medicines, and several treatments may be necessary. The safety question is whether each medicine remains suitable within the complete regimen. WHO identifies medication safety in polypharmacy as a priority and recommends involving patients and professionals from different disciplines in reviewing treatment. An appropriate review considers the person's health and priorities alongside the prescriptions, rather than judging care solely by the number of medicines. [WHO technical report](https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.11)

Who should ask for a structured medication review?

NICE recommends care tailored to multimorbidity for adults prescribed 15 or more regular medicines. It also advises considering this approach for people taking 10 to 14 medicines, or fewer when adverse-event risk is particularly high. These thresholds help identify patients needing attention; they do not establish a universally safe pill count. Frailty, falls and difficulty managing daily treatment also warrant consideration. [NICE multimorbidity guidance](https://www.nice.org.uk/guidance/ng56/chapter/recommendations)

A structured review examines what every medicine is for, whether it is helping, possible harms and necessary monitoring. Patients should include nonprescription products and complementary medicines, and describe how they actually take their treatment. Useful discussion points include suspected side effects, confusing instructions and doses that are difficult to fit into daily life. NICE says the review may be led by a pharmacist or another appropriately skilled health professional working within a multidisciplinary team. [NICE medicines optimisation guidance](https://www.nice.org.uk/guidance/ng5/chapter/Recommendations)

Do medication reviews prevent hospital admissions?

A 2023 Cochrane review examined 38 trials involving 18,073 older people across 19 countries. The interventions included pharmaceutical care and other approaches to improving prescribing. The authors found uncertainty about improvements in prescribing appropriateness, while pharmaceutical care may have made little or no difference to hospital admissions or quality of life. Evidence quality and differences between studies limited confidence; the search covered research available through January 2021. These findings do not justify promising that every medication review will prevent hospitalization. [Cochrane systematic review](https://doi.org/10.1002/14651858.CD008165.pub5)

The practical objective is an agreed treatment plan with clear follow-up. NICE advises considering medicines that might need to be started as well as those that could be stopped. When treatment is reduced or discontinued, clinicians should monitor the effects and consider restarting it if appropriate. A review should therefore produce a reasoned decision about each treatment, with responsibility for coordination clearly assigned. [NICE multimorbidity guidance](https://www.nice.org.uk/guidance/ng56/chapter/recommendations)