Pharmaceutical interventions are addressed by a number of papers in this month's issue of the journal. Drug therapy is the major intervention offered by the NHS to enhance and sustain the health of the population. Medicines cost the NHS in excess of £10 billion annually, with the total cost and number of prescriptions steadily rising; the majority of prescribing occurs in general practice. Given this investment, together with the shift of chronic disease management to primary care, GPs need to ensure their prescribing is effective in maximising health gains while minimising risks to patients.
THE EVIDENCE
Polypharmacy is arguably one of the most pressing prescribing issues. There is no formally accepted definition, but it is usually considered as concurrent prescribing of at least four or five drugs. In a German study, over a quarter of older patients in primary care were found to be on five or more medicines,1 and a recent Italian study found that over 35% of older patients were exposed to polypharmacy.2 Data from the Swedish Prescribed Drug Register also show a prevalence of over 5% of patients in their 40s, and around 12% of those in …