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Patient centred respiratory prescribing 

Medication is by far the most common form of medical intervention for many acute and chronic conditions with around 280,000 items prescribed every day in Scotland, around 21,000 being for respiratory medicines. 10

The term polypharmacy itself just means “many medications” and is defined to be present when a patient takes two or more medications.

Drug therapy can be highly effective in preventing disease or slowing disease progression, with guidelines for single diseases recommending the use of a variety of evidence-based drug treatments. However, there is often a mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individuals. It is important to note that polypharmacy is not necessarily a bad thing, it can be both rational and required.

It is recommended that patients are reviewed using the Polypharmacy 7 steps guidance.8 Accredited* Polypharmacy training course is available on TURAS (*3 points of external CPD by Royal College of Physicians, United Kingdom). The training equips healthcare professionals including doctors, nurses and pharmacists to undertake comprehensive person-centred medicines reviews. The training can be accessed at NHS Education for Scotland on TURAS, learn or for more information, visit www.isimpathy.eu.

Environmental impact of polypharmacy and healthcare

Over-prescribing is commonplace, accounting for at least 10% of all prescribed medications. It is estimated that up to 11% of unplanned hospital admissions are attributed to harm from medicines 8.  About half of these admissions are deemed to be preventable, through methods such as effective review, following the seven step polypharmacy process.

The healthcare industry is increasingly asked to account for the negative environmental impact generated through providing medical care. In Scotland, every 10 days a 10-tonne truck of medicines waste (returned to community and hospital pharmacies) is transported for incineration. There are the associated costs for incineration; travel costs and the environment impact (see the figure below) and in addition to the direct costs of the unused medication.

Regular medication reviews to address inappropriate polypharmacy in respiratory (and other co-morbidities) should ensure that the environmental impact of prescribing is reduced.


Annual cost of managing medicines waste in Scotland