Medication Management in Patients With Polypharmacy in Primary Care: A Scoping Review of Clinical Practice Guidelines

OBJECTIVE: Inappropriate polypharmacy increases the risk of medication-related issues. Adequate management of polypharmacy is a challenge involving different healthcare professionals, complex decision-making and ideally including patient involvement. The objective of this scoping review was to provide an overview of national recommendations for medication management of patients with polypharmacy in primary care.

METHODS: A scoping review of clinical practice guidelines focusing on medication management in adults with polypharmacy, applicable to primary care was performed. Databases (G-I-N, Turning Research into Practice and PubMed), network, and a global report were screened for guidelines published after 2000 in English, Dutch, German, Spanish, French, or Russian. Raw data were extracted in duplicate using an extraction framework focusing on strategies, involvement of professionals, patient involvement, and implementation. Qualitative content analysis was used. Guideline quality was assessed using AGREE-II. The study was registered with the Open Science Framework.

RESULTS: Eight guidelines originating from eight countries were included. The most common recommended strategy was a medication review conducted by a general practitioner and/or a community pharmacist. Tasks and target population differed per guideline. Most guidelines recommended involving the patient in the process, mostly to elicit the patient's experiences and treatment goals. Few guidelines included advice on the implementation of recommendations. Three out of eight guidelines were of good quality (AGREE-II score >70% in 5/6 domains).

CONCLUSIONS: Most guidelines recommended a medication review, with patient involvement, as a strategy for medication management in polypharmacy in primary care. Guidance on task division and implementation of guidelines in practice was less clear. This review illustrates room for guideline improvements.