A look at polypharmacy and the potential risks

Polypharmacy – when a person is using five or more medications at the same time – is a growing part of the nation’s healthcare. While it might be necessary to manage chronic and complex conditions, it is not without clinical risk.

New Australian Institute of Health and Welfare (AIHW) data shows polypharmacy is most common among older people, with 40% of those aged 75 and older dispensed five or more medications through the PBS.

Polypharmacy impacted 20% of people aged 64-74 and 9.5% of those aged 55-64. Rates were lowest among children and around 0.2% for those aged 15-24.

In total, around 1.9 million Australians (7%) experience polypharmacy.

“The steady increase in polypharmacy rates with age is consistent with the increase of chronic conditions as age increases and the increasing treatment complexity in older age groups,” the report states.

“As Australia's population continues to age, the number of people exposed to multiple medicines is likely to increase, with implications for medicine safety, appropriate medicine use, and healthcare utilisation.”

RACGP WA Deputy Chair Dr Julia Rawlinson said it was not unusual that older populations were on multiple medications.

“We know the more medication someone is on the more risks we have in terms of adverse events, medication related side effects, falls – we often see an increased risk of falls in people with polypharmacy – and then that leads to increased hospitalisations,” she told Medical Forum.

“Sometimes we get increased adherence issues too with people who are taking multiple medications.”

The report is the first of its kind to look at polypharmacy in Australia. Polypharmacy was identified as a priority area for medication safety by the World Health Organization in 2019.

The report was based on PBS prescribing data. Medicines provided through private prescriptions were not included, therefore results may underestimate the true extent of polypharmacy in Australia, the AIHW said.

Monitoring the rate of polypharmacy in the population may help identify those at greater risk of medicine-related harm and help inform health service planning, medication safety initiatives and targeted medication safety reviews.

“While polypharmacy can be clinically appropriate and necessary for effective treatment, it is also associated with an increased risk of medication-related harm,” the AIHW report states.

“These risks may include adverse drug reactions, interactions between medicines, and the chances of not taking medicines as prescribed. These risks increase as the number of medicines rises, highlighting the importance of regular medication reviews and appropriate prescribing.”

Dr Rawlinson said the data served as a reminder that regular medication reviews with a GP are important.

“In general practice we try and do that on an annual basis, and we try to deprescribe when there’s no clear evidence or benefit,” she said.

“I often discuss that with my patients and if the side effects outweigh the benefits then we have a discussion about deprescribing.

“Under the Medicare Benefits Scheme you can get a medication review completed by a pharmacist for your patient. It’s another set of eyes that gives us suggestions as to medications that could be changed or reduced.

“Often a pharmacist will go to someone’s house to conduct these reviews and they will be able to look at what over the counter medications a patient may be taking as well.”

The RACGP offers a range of resources on deprescribing.