Qualitative insights into identifying and managing polypharmacy: Patient, pharmacist and GP perspectives

Background Polypharmacy is a global priority due to potential harms, including adverse drug events, hospitalisations and high treatment burden. Overall, these outcomes have shown little improvement despite numerous interventions indicating that current approaches to identify and manage polypharmacy remain insufficient. Aim To understand how polypharmacy is identified and managed in everyday primary care from patient, pharmacist and GP perspectives. Design and Setting Qualitative semi-structured interviews with 12 patients and 12 professionals (7 clinical pharmacists, 5 GPs) across Greater Manchester. Method Reflexive thematic analysis supported by Normalisation Process Theory and Constant Comparison as sensitisation tools. Results Polypharmacy was widely seen as important work but, in practice, inconsistent case-finding and unclear purposes for polypharmacy medication reviews were reported. Patients viewed medications as essential tools to sustain biopsychosocial elements of life, contrasting with practitioners' clinical priorities to mitigate potential harm. Polypharmacy work routinely contained layers of hidden complexity, which was often overwhelming and placed a heavy emotional burden on patients and professionals. Both patients and professionals required training and experience to effectively manage these complexities. Though a protocol-driven approach was sufficient for simple medication issues, only a longer-term approach, predicated on trust, continuity, relationships and open discussions encouraging healthy conflict, appeared to engage with deeper complexities. Conclusion Polypharmacy work is fraught with complexity and uncertainty, lacking standardised case-finding and clear purpose for both patients and professionals. Better models of care are needed to meet this challenge, encouraging a shift beyond a biomedically dominated protocol-driven approach to a more longitudinal and relational approach.