Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5910_Библиотеки_им_академика_М_И_Перельмана

tinely prescribed, for instance after an acute myo­cardial infarction. Polypharmacy is the concurrent use of multiple medications, and while polyphar­macy is often dened as routinely taking a mini­mum of ve medicines [6], it is being more frequently suggested that the emphasis should be on evidence-based and appropriateness of the prescription rather than the number [3, 7]. All medications that a patient is using should be con­sidered when reviewing polypharmacy for its appropriateness, including traditional medica­tions, complementary preparations as well as those purchased by the patient over the counter. Despite increasing multimorbidity, most medical research, clinical guidelines and contractual agreements (such as pay-for-performance initia­tives such as the General Medical Contract (GMS) that sets out what GPs are tasked and paid to deliver on for reimbursement) are focused on the management of single disease states [8]. In these multimorbid patients, referrals to special­ists and individually treating each condition inev­itably lead to the use of multiple medications, that is, polypharmacy [9]; the risks and benets of which are largely unproven and often unpredictable.

patient moves across different healthcare set­tings, that is, through transitions of care. The increased risk of harm is not always offset by increased benets, and for many preventive medicines, such benets may never be realised due to a shortened life expectancy. The risk of harm is generally higher in older people with multimorbidity than in younger patients due to pharmacokinetic factors, such as reduced ability to clear drugs (e.g., due to kidney and/or liver impairment) and pharmacodynamic factors such as increased vulnerability to drugs’ adverse effects (due to general frailty, and drug–drug and drug–disease interactions) and medication burden [8, 10, 11].