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Generalist solutions to overprescribing: a joint challenge for clinical and academic primary care

  • Joanne Reeve (a1) and Rebecca Bancroft (a2)

Polypharmacy is a phenomenon of modern health care that can offer benefits in terms of patient outcomes. Known risks associated with so-called inappropriate polypharmacy can be reduced through good medicine management and appropriate use of clinical guidelines. However, we now see a growing literature highlighting additional risks to individual well-being and social functioning not recognised within these existing frameworks – the burden of polypharmacy and a problem of overprescribing. We need a new approach to defining and understanding inappropriate polypharmacy from a person-centred perspective. This paper discusses practice-based work exploring the impact of introducing generalist needs assessment for elderly patients with multiple chronic morbidities. The work suggests that generalist care offers something ‘different’ to current chronic disease management models, but highlights the need for formal evaluation to determine whether it is ‘better’. We call for new collaborative research between clinical and academic partners to address the question as to whether generalist care offers solutions to the problems of the burden of polypharmacy.

Corresponding author
Correspondence to: Dr Joanne Reeve, Department of Health Services Research, University of Liverpool, 1–5 Brownlow Street, Liverpool L69 3GL, UK. Email:
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S. Anthierens , A. Tansens , M. Petrovic T. Christiaens 2010: Qualitative insights into general practitioners views on polypharmacy. BMC Family Practice 11, 65.

L. Bregnhoj , S. Thirstrup , M.B. Kristenson , L. Bjerrum J. Sonne 2007: Prevalence of inappropriate prescribing in primary care. Pharmacy World Science 29, 109115.

D.C. Chan , Y.T. Hao S.C. Wu 2009: Polypharmacy among disabled Taiwanese elderly: a longitudinal observational study. Drugs and Aging 26, 345354.

C. Fox , K. Richardson , I.D. Maidment , G.M. Sawa , F.E. Matthews , D. Smithard , S. Coulton , C. Katona , M.A. Boustani C. Brayne 2011: Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Aging Study. Journal of the American Geriatric Society 59, 14771483.

H.M. Holmes , D.C. Hayley , G.C. Alexander G.A. Sachs 2006: Reconsidering medication appropriateness for patients in late life. Archives of Internal Medicine 166, 605609.

E.S. Huang , A.J. Karter , K.K. Danielson , E.M. Warton A.T. Ahmed 2010: The association between the number of prescription medicines and incident falls in a multi-ethnic population of type-2 diabetes patients: the Diabetes and Aging Study. Journal of General Internal Medicine 25, 141146.

I. Illich 1974: Medical nemesis. The Lancet 303, 918921.

D. Mant 2008: The problem with usual care. British Journal of General Practice 58, 755756.

C. May , V. Montori F. Mair 2009: We need minimally disruptive medicine. British Medical Journal 339, 485487.

R. Moynihan , J. Doust D. Henry 2012: Preventing overdiagnosis: how to stop harming the healthy. British Medical Journal 344, e3502.

M. Pirmohamed , S. James , S. Meakin , C. Green , A.K. Scott , T.J. Walley , K. Farrar , B.K. Park A.M. Breckenridge 2004: Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18 820 patients. British Medical Journal 329, 1519.

J. Reeve 2010b: Protecting generalism: moving on from evidence-based medicine? British Journal of General Practice 60, 521523.

J. Reeve , G. Irving C. Dowrick 2011: Can generalism help revive the public health vision? Journal of the Royal Society of Medicine 104, 395400.

K. Stange 2009: The generalist approach. Annals of Family Medicine 7, 198203.

J. Stehlik D.O. Taylor 2004: And an ARB makes nine: polypharmacy in patients with heart failure. Cleveland Clinic Journal of Medicine 71, 674676.

A.E. Stuck , A.L. Siu , G.D. Wieland , J. Adams L.Z. Rubenstein 1993: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet 342, 10321036.

E.D. Shapiro D.L. Coleman 2000: The scholarship of application. Academic Medicine 75, 895898.

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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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