Polypharmacy as a chronic condition: a diagnostic mindset for safer and smarter care
File(s)
Published version
Author(s)
Jerjes, Waseem
Majeed, Azeem
Type
Journal Article
Abstract
Polypharmacy is typically seen as an unavoidable consequence of multimorbidity and aging, with clinicians addressing complex medication lists unsystematically. In this perspective, we argue that polypharmacy should be managed as a chronic condition. Like diabetes or hypertension, for example, the medication burden shows persistence, progression in its absence despite active management, predictable complications (such as falls, delirium, renal injury, functional decline), and a need for structured surveillance. We introduce a pragmatic diagnostic framework that moves beyond pill counts to modality-agnostic, regimen-level risk across prescribed and non-prescribed medicines. Diagnosis rests on prolonged exposure, composite burden indices (e.g., anticholinergic/sedative load), medication-related complications or prescribing cascades, and the need for a planned review. As biologics, gene therapies and long-acting formulations can lower tablet numbers while increasing monitoring, administration, and interaction complexity. We treat polypharmacy as cumulative pharmacodynamic and operational burden. We advocate stage matched care with unique, functional aims—decreasing the harmful burden instead of mass deprescribing—and position a structured medication review as the standard for polypharmacy with support from pharmacists, shared decision making, and safety netted taper plans. The framework fosters patient-centred care, embedding continuity and equity, and outlines a concise outcome set that integrates pharmacometric measures with patient-reported function and treatment burden. At the systems level, the framework enables registries, recall systems, decision support, and audit/feedback mechanisms to shift from sporadic medication list clean-up to a structured, measurable long-term program. Redefining polypharmacy in this way aligns clinical practice, education, and policy with real-world evidence, fostering a cohesive pathway to safer, streamlined, and more patient-centred care in community settings.
Date Issued
2025-10-01
Date Acceptance
2025-10-16
Citation
Journal of Clinical Medicine, 2025, 14 (20)
ISSN
2077-0383
Publisher
MDPI AG
Journal / Book Title
Journal of Clinical Medicine
Volume
14
Issue
20
Copyright Statement
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41156256
PII: jcm14207388
Subjects
anticholinergic burden
chronic condition management
deprescribing
medication review
polypharmacy
prescribing cascades
primary care
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
7388
Date Publish Online
2025-10-19