Rationalisation of polypharmacy in practice: a survey of physicians and pharmacists

Background: In the literature, polypharmacy is commonly defined as using five or more medicines. Little is known about how physicians and pharmacists define and assess polypharmacy in practice. Aim: This study determined how expert physicians and pharmacists define and assess polypharmacy in practice. Methods: An online survey was sent to 25 expert physicians and pharmacists who were chosen if they had done significant work in the area of polypharmacy through major research, clinical practice or both, to identify how experts define and assess polypharmacy in practice. Results: Twenty-two participants completed the survey (88% response rate). There was strong agreement between experts, including which factors are important when assessing polypharmacy (intraclass correlation coefficient = 0.94). Respondents used the number of medicines (n = 18 respondents; 56.3% of all definitions), such as five or more medicines, and brief descriptions (n = 4 respondents; 43.7% of all definitions), such as assessing appropriateness given comorbidities, to define polypharmacy. Respondents commonly indicated patient factors such as functional status (n = 11 respondents; 50%) and medicine-related factors such as drug–drug interactions (n = 11; 50%) as important when assessing polypharmacy. Experts reported low use of externally validated polypharmacy tools during polypharmacy assessment, with 36.4% (n = 8) being unfamiliar with or never or rarely using these tools. Conclusion: Medication- and patient-related factors beyond a medicines count were deemed important in assessing polypharmacy. Given the low use of externally validated polypharmacy tools, strategies that include important medication- and patient-related factors are required to facilitate polypharmacy rationalisation.