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Medication nonadherence can be intentional when polypharmacy and high pill burden become overwhelming for patients. At the Bruyere Geriatric Day Hospital (GDH), patients referred for medication review take an average of 15 medications.1 The resulting complex regimens can lead to confusion about indications for medications, lack of certainty in their effectiveness and frustration. Patients increasingly believe that the multiple medications may not be needed and often elect to stop taking some or all of them. This case illustrates an approach to reducing the pill burden of polypharmacy that includes eliminating medications that are not working or are potentially harmful, reducing dosing frequency and using fixed combination products. Ultimately, identifying barriers to adherence and enhancing the patient’s understanding of the indication and proper use of medications, while reducing pill burden, assisted in improving adherence and disease control during a 12-week admission. A description of the GDH processes and in particular, communication about medication-related care, can be found in Appendix 1 (www.cpjournal.ca).
Farrell et al. (Sun,) studied this question.