Clinical Learning
Clinical 9: Multimorbidity and polypharmacy
Person-centred review of multimorbidity, treatment burden and polypharmacy using NICE NG56.
Clinical safety: Use current guidance, local policy and patient-specific judgement.
Learning objectives
• Identify people who may benefit from a multimorbidity approach • Recognise treatment burden and medicines-related risk • Set goals based on what matters to the person • Review medicines for likely benefit and harm • Coordinate an individualised management plan across services
Clinical safety note
Medication changes should be individualised and clinically supervised. Deprescribing may require gradual withdrawal, monitoring or specialist advice. Check current BNF and disease-specific guidance before changing medicines.
Why multimorbidity changes the consultation
Single-condition guidelines are often based on populations with fewer conditions and medicines. In a person with multimorbidity, following every disease-specific recommendation can create substantial treatment burden, interactions, conflicting advice and reduced quality of life. NICE NG56 therefore asks clinicians to consider the whole person, their goals and the cumulative burden of treatment.
Who may benefit
Consider a multimorbidity approach when people struggle to manage treatments or daily activities, receive care from multiple services, have physical and mental health conditions, frailty or falls, frequent unplanned care, or substantial polypharmacy. NICE recommends a multimorbidity approach for adults prescribed 15 or more regular medicines, and consideration for those taking 10 to 14 or fewer medicines with particular risk factors.
Reviewing treatment burden
Establish what the person is trying to achieve, which treatments matter most, what causes burden, and where likely benefit is small or uncertain. Review medicines and non-drug treatments for effectiveness, adverse effects, interactions, duplication and alignment with the person's priorities. Deprescribing is not simply “stopping tablets”; it is a structured shared decision about benefit, harm and goals.
Coordination and planning
Agree an individualised plan that includes priorities, treatments to continue/change, follow-up, who coordinates care, and how urgent problems should be managed. Communicate the plan across services. Be cautious about frailty assessment during acute illness; physical performance measures can be misleading when a person is acutely unwell.
