How Primary Care Clinicians Can Approach Polypharmacy and Deprescribing

Key Highlights

• Clinicians should treat prescriptions as ongoing therapeutic trials, reassessing medication safety, efficacy, tolerability, dose, and patient fit at each visit.
• Deprescribing should be guided by shared decision-making and patient goals of care, rather than by speed, patient autonomy alone, or clinician-directed decision-making alone.
• Strong clinician-patient rapport is central to successful deprescribing because patients’ trust in medication decisions is closely tied to their trust in the clinician.

Polypharmacy remains a growing challenge in primary care, particularly among older adults and patients with multiple chronic conditions. Following his Practical Updates in Primary Care session, W. Clay Jackson, MD, DipTh, discusses how clinicians can approach medication review as an ongoing, patient-centered process rather than a one-time prescribing decision. In this Q&A, Dr Jackson highlights practical strategies for identifying when medications may no longer align with a patient’s current needs, goals, safety profile, or quality of life.

Additional Resource: https://www.hmpglobalevents.com/pupc/agenda

Consultant360: What were some of the key themes of your presentation?

W. Clay Jackson, MD, DipTh: All prescriptions are trials—we should not view pharmacotherapy as a lifetime contract with a noncompete clause. During each patient visit, we should look at each medication to assess whether ongoing therapy at a given dose makes sense for that patient in their current condition. We should carefully weigh safety, efficacy, and tolerability using a shared decision-making approach.

Consultant360: Why is this topic particularly relevant right now?

Dr Jackson: There is an increased emphasis on patient safety, as well as public interest in minimizing prescription drug burden when possible. The HHS Secretary has indicated recently that CMS may offer additional remuneration for patient visits that include documented efforts toward deprescribing. We can capture that momentum to have engaging conversations with our patients about what is important to them in their health journey.

Consultant360: What were the most important takeaways from your session?

Dr Jackson: For deprescribing, it is direction, not speed, that is important. Shared decision-making—not unmitigated patient autonomy or unbridled paternalism—offers the best therapeutic framework from which to consider deprescribing.

Consultant360: What gaps in our knowledge do you feel still remain on this topic?

Dr Jackson: I think the current research has focused more on qualitative gains, such as stopping medications, and we could use more studies that look at quantitative gains, such as lower doses.

Consultant360: Anything else you would like to add?

Dr Jackson: People do not believe in clinicians because of medicines; they believe in medicines because of clinicians. Clinicians who do a good job of establishing rapport are going to have the most success when it comes time to consider deprescribing.

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