Tools to support medication management in people with multimorbidity and polypharmacy

With an ageing population and increasing rates of multimorbidity, polypharmacy has become a common part of the healthcare landscape. Polypharmacy is sometimes necessary and appropriate; however, it is associated with increased risk of medication-related problems, such as nonadherence and adverse events.

The Department of Health and Aged Care recently published a handbook that collates examples of tools designed to support medication management in people with multimorbidity and polypharmacy.¹ The Quality Use of Medicines and Pharmacy Research Centre at the University of South Australia was commissioned to develop the handbook.

The handbook includes examples of tools designed to identify or manage:

• medicine regimen complexity
• medicine nonadherence
• potentially inappropriate medicines in older people
• potential underprescribing in older people
• medicine-related adverse effects
• cumulative adverse effects from multiple medicines (e.g. anticholinergic burden)
• medicine-related problems and risk of hospital readmission
• patients’ willingness to have medicines deprescribed
• switching and tapering medicines.

It includes at least one tool for each of these areas, and includes tools developed for Australian practice. Summaries of each tool are provided, including brief information on its purpose, settings for use, audience, validity and reliability, and limitations.

The handbook is not an exhaustive list of all tools, and it does not include disease-specific tools. Some tools were developed outside of Australia, and the authors warn these should be used with caution as some medicines may not be available in Australia or may come in different strengths or formulations.¹ The handbook has a disclaimer that inclusion of tools in the handbook is for information and education purposes only, and does not represent endorsement of use.¹

In 2024 the Council of Australian Therapeutic Advisory Groups (CATAG), with the Medicines Advice Initiative Australia, also published a toolkit that includes links to various tools for identifying and managing polypharmacy and the cumulative effects of multiple medicines.² The impetus for the CATAG publication was that cumulative toxicity may be missed if there is no formal assessment, especially during short-term acute care scenarios.²

When used in clinical practice, it is important that tools to support medicine management are not used as a substitute for independent professional assessment, and that patient goals and preferences are considered in decisions about drug therapy. For example, lists of potentially inappropriate medicines do not take account of all patient circumstances; there may be instances where medicines on these lists are appropriate and consistent with patient goals.³ There may also be medicines that a person is taking that are not included on these lists but are still inappropriate for the individual because of patient-specific factors.

The extent to which tools described in these 2 resources have been validated is variable. Limited information is provided on how, or in what populations, validity and reliability were assessed.^1,2 Sometimes a tool may perform differently in different populations or settings. When selecting a tool to support medicine management (or for research or quality improvement) it is important to consider these factors.

 

References

1. Roughead L, Widagdo I, Kemp-Casey A. Handbook of tools to support medicine management in multimorbidity and polypharmacy. Department of Health, Disability and Ageing; 2025. [cited 2025 May 27]
2. Council of Australian Therapeutic Advisory Groups. Addressing the hidden risk of cumulative medicines. 2024. [cited 2025 May 27]
3. Choo A. Potentially inappropriate medicines for older people: consensus-based lists. Aust Prescr 2025;48:129-33.