Frequently used for symptomatic relief, nonprescription drugs (NPDs) accounted for over €2 billion in over-the-counter sales in France in 2023. Their often uncertain benefit-risk balance makes them a relevant context for shared decision-making (SDM) for general practitioners (GPs) and community pharmacists (CPs), who play a key role in supporting patients in their drug choices. DECIdE (shared DECIsion in hEalth) is a patient decision aid designed to provide access to trustworthy data and foster SDM on NPDs.To assess the effect of DECIdE on decisional conflict in primary care.DECIdE was evaluated in a cluster-randomized controlled trial (RCT) comparing a control group (usual care) to an intervention group using DECIdE. Adults presenting with a symptom or a request related to a nonprescription drug were included. The primary endpoint was the Decisional Conflict Scale (DCS) score : a self-administered questionnaire consisting of 16 items rated on Likert scales covering information, values, support, uncertainty, and perception of the decision. The main analysis compared groups using mixed linear models accounting for the fixed effect of group allocation and the random effect of healthcare professionals.The RCT involved 24 GPs and 24 CPs (clusters) and included 200 patients. It did not show a significant difference in the DCS total score between groups. However, the proportion of patients with a high DCS (> 37.5%) was lower in the intervention group (4.3% vs 17.7%, p = 0.031) and the Information subscale score was reduced (p = 0.024). Healthcare professionals’ DCS were also lower in the intervention group (14.5% vs 22.1%, p = 0.014 in the propensity score–weighted analysis).The main strength of this study is the combination of a rigorous cluster RCT design with real-world implementation in primary care, while the main limitation was the recruitment challenge in a strained healthcare access context. Its multi-professional approach appears to be unique in the literature on OAD assessments.DECIdE is available through a dedicated website. It could contribute to a more appropriate and evidence-informed use of symptomatic medicines, particularly in the context of self-medication.

Drug prescribing is a core component of patient management by general practitioners (GPs). No study has yet examined the most commonly prescribed medicines by GPs at the national level in France. However, simply counting dispensed boxes may bias interpretation by comparing small packages (e.g. paracetamol) with packages covering several months of treatment (e.g. antihypertensives). The use of the defined daily dose (DDD) concept enables homogeneous comparisons between drugs.To identify the ten most frequently prescribed oral medicines by GPs in adults between 2014 and 2023 in XXXX, expressed both as number of boxes and as DDDs.We conducted a descriptive observational study from 2014 to 2023 using the XXXX national reimbursement database XXXXX. Oral treatments prescribed by GPs for adults were included, excluding medicines without a defined DDD. Quantities were expressed as numbers of boxes and as DDDs.By number of boxes, the most frequently prescribed medicines were paracetamol (47.4 boxes/person/year), acetylsalicylic acid (5.5 boxes/person/year), metformin (3.3 boxes/person/year), followed by amoxicillin, levothyroxine, bisoprolol, furosemide, alprazolam, omeprazole and esomeprazole. By DDDs, the most prescribed medicines were paracetamol (319.9 DDD/1000 persons/day), ramipril (281.8 DDD/1000 persons/day), atorvastatin (257.8 DDD/1000 persons/day), followed by furosemide, metformin, lercanidipine, amlodipine, perindopril, prednisolone and esomeprazole.This analysis highlights the major contribution of chronic treatments (cardiovascular disease, diabetes) to GP prescribing; in terms of DDDs, these conditions account for the vast majority of prescribed doses. In contrast, counting boxes captures, in addition to chronic treatments, the acute care dimension of general practice, illustrated by the presence of amoxicillin. Paracetamol ranks highly in both metrics. This dual approach provides a more comprehensive description of the spectrum of conditions managed in general practice. Nevertheless, DDD-based estimates have inherent limitations, and prescriptions that are not reimbursed or not dispensed are not captured in XXXX.This study offers perspectives for medical education and for describing general practice activity to policymakers.

The daily use of five or more medications is known as polypharmacy, and it is a growing public health concern among the elderly because it greatly raises the risk of adverse drug events, hospitalizations, and functional decline. To ensure safer prescribing in Albanian primary care settings, localized data on its prevalence and an awareness of PHC providers' viewpoints are crucial.To figure out the prevalence of polypharmacy among adults 70 years of age or older in the Tirana region,  and to evaluate the attitudes and knowledge of PHC physicians regarding this clinical concept.A cross-sectional study. With an estimated 9,227 people who are eligible, the study population includes  registered adults in Tirana who are at least 70 years old, enrolled in a PHC facility. FP and phone contacts were  used to recruit a representative sample of 400 participants. Standardized questionnaires, direct medical record review, and physician consultation serve to gather data regarding demographics, chronic conditions, and complete medication regimens. A different survey is utilized in a parallel arm to assess the primary care providers' knowledge and attitudes. Descriptive statistics will be utilized during statistical analysis to determine prevalence and describe provider’s opinions.Since the study is still in progress, accurate numerical results are not yet available. Given the age and multimorbidity of the population, a quantified baseline prevalence rate of polypharmacy is anticipated to be significant. It is expected that the provider assessment will provide information about current knowledge and clinical procedures concerning the management of polypharmacy.The expected outcomes will benchmark the primary care workforce's capacity to handle polypharmacy and provide the first accurate information on its prevalence in a significant Albanian region. To improve medication safety, this will draw attention to a likely serious clinical problem and highlight any educational or systemic gaps that may need to be addressed.This study is designed to determine the polypharmacy extent among the elderly Albanian population in Tirana and assess the preparedness of PHC physicians to handle it. The results are expected to highlight the significance of incorporating systematic medication review into geriatric care to improve patient safety and therapeutic outcomes.

Polypharmacy, the concurrent use of multiple medications, is increasingly common among older adults, particularly those with hypertension. While often necessary for managing comorbidities, it can reduce quality of life (QoL) due to adverse drug events, interactions, and treatment burden. Older adults are especially vulnerable due to age-related physiological changes, multiple chronic conditions, and increased susceptibility to side effects, making careful medication management essential.This review aims to synthesize current evidence on the impact of polypharmacy on QoL in older adults with hypertension and to discuss practical strategies for primary care.A literature search was conducted in PubMed in December 2025 using the terms “polypharmacy,” “older adults,” “quality of life,” and “hypertension.” The search yielded 20 articles.The studies comprised observational cohorts, cross-sectional studies,systematic reviews,meta analyses and randomized controlled trials evaluating interventions such as deprescribing or medication optimization. Key information on medication burden, adverse effects, and quality of life was collected to provide a comprehensive overview of polypharmacy’s impact in older adults with hypertension.Most studies consistently demonstrated that polypharmacy is associated with lower QoL, affecting physical, mental, and social well-being. Increased risk of adverse drug reactions, hospitalizations, and healthcare utilization were common findings. Evidence suggests that structured medication reviews, pharmacist-led interventions, and patient-centered deprescribing can significantly improve QoL and reduce medication-related risks. Comorbidities and functional limitations amplify polypharmacy’s negative impact. Shared decision-making and individualized care plans were highlighted as critical strategies for optimizing outcomes.Primary care providers play a central role in mitigating the effects of polypharmacy. Regular medication reviews, monitoring drug interactions, deprescribing unnecessary medications, and collaborative care with pharmacists and caregivers are critical for enhancing patient-centered outcomes. Awareness of the QoL implications of polypharmacy can guide treatment optimization and improve adherence.Polypharmacy negatively affects QoL in older adults with hypertension. Targeted primary care interventions, including medication optimization and deprescribing, are vital to improve patient outcomes. Further research is needed to develop standardized protocols for polypharmacy management in this population.

Inhalers containing bronchodilators and corticosteroids are the cornerstone of asthma therapy. Adherence to prescribed medication is critical to successful management.To study inhalers adherence in a large cohort of asthma patients, and  to assess the effect of specific inhaler on adherence.We performed a retrospective cohort study in Clalit Health Service (CHS), an HMO serving >50% of the population of Israel. CHS members aged 40-80 years with a diagnosis of asthma, who filled ≥1 prescription/year 2017-2019 (regular users) for at least one inhaler containing inhaled corticosteroids (ICS), long-acting beta-adrenergics (LABA), and/or long-acting anti-muscarinics (LAMA) were included. Filled monthly prescriptions were used as a proxy for actual medication use. The primary endpoint was the proportion of adherent users (purchase of ≥3 inhalers/yr in 2018).45,801 asthma patients (age 68.4±7.1 yrs., 45% men, 40% ever smokers) were identified. 18,568 were regular inhaler purchasers (40% of total). 99% of the patients got inhalers containing steroids, and 93% got combination inhalers with both steroids and LABA. 95.7% used only one inhaler from the study inhalers. Adherence rate varied across inhalers, ranging from 51% to 77% for purchasing for at least 3 months. In multivariate analysis, adherence increased with age. Men and smokers were more likely to be adherent. Patients with good adherence were more likely to receive oral steroids (OR=1.09 [1.06, 1.12]) and less likely to visit the ER during 2018 (OR=0.89 [0.83, 0.97]). There was no difference in hospitalizations between more and less adherent patients.Adherence rates among asthma patients differ from those for other chronic medications.Asthma adherence rates are low and vary with various inhalers.

Polypharmacy, the use of multiple medications, offers benefits but can lead to negative outcomes like increased patient safety concerns, a poor patient experience, and wasted healthcare resources. Despite hundreds of studies on polypharmacy interventions, there is little evidence of these outcomes improving. There remains a gap in understanding the real-world experiences of how patients are identified for review, how consultations unfold and how effective those conversations are in addressing complex polypharmacy issues.To understand the everyday experiences of the identification and management of problematic polypharmacy from patient, pharmacist and GP perspectives, to identify potential opportunities for improvement.Qualitative study incorporating semi-structured interviews of 12 patients and 12 professionals (5 General Practitioners and 7 clinical pharmacists) purposively recruited from 6 General Practices with variations in geography, deprivation, list size, and staff mix. Thematic analysis was informed by the Normalisation Process Theory (NPT) and Constant Comparison techniques.In practice, identifying and managing polypharmacy lacked focus with inconsistent case-finding. Dealing with polypharmacy exposed layers of complexity, compounded by complex multimorbidity, ambiguous messages from secondary care, challenging psychosocial issues, non-specific symptoms (e.g. fatigue, insomnia), and conflicting priorities between patients and practitioners. Patients viewed medications as essential tools to sustain biopsychosocial wellbeing, contrasting practitioners’ clinical priorities to reduce potential harm. To highlight some of the breadth of approaches in managing this complexity, we grouped them into 4 main approaches for patients and professionals, employed according to differing levels of complexity. The 4 main approaches for professionals included: Protocol-driven approach; Prioritisation approach; Multidisciplinary approach; and Longitudinal follow-up approach. Likewise, patients also adopted 4 approaches including: Unquestioning acceptance; Outward acceptance; Proactively engagement; and Healthy confrontationThough ‘Protocol-driven’ approaches and ‘Unquestioning acceptance’ were the most efficient for simple medication queries, only a ‘Longitudinal’ follow-up approach, predicated on trust, continuity and building relationships over time, appeared to deal with deeper complexities within polypharmacy work.Models of care to address problematic polypharmacy must go further and recognise the needs of both patients and practitioners in engaging with deeper complexity if we are to improve patient outcomes and achieve authentic shared decision-making.

Population aging leads to a higher prevalence of multimorbidity and polypharmacy among older adults in Europe. Potentially inappropriate medications (PIMs) and polypharmacy are linked to poor health outcomes including hospitalizations and reduced quality of life. To improve geriatric health outcomes in XXX, a rural region is implementing a pilot project, the XXX Interprofessional Outpatient Therapy for Geriatric Patients.To evaluate the effect of the medication review within the XXX programm on polypharmacy and PIM use and estimate potential upscaling, based on the results of the nationally representative Health of Older People in XXX study (XXX).Participants aged ≥70 years in XXX are enrolled by their family doctor and randomized to standard care or to XXX—a multimodal intervention including a comprehensive physician-led medication review. Medication use is assessed by an independent study nurse at baseline, 4 and 8 months. PIMs are identified using XXX list. Prevalence of polypharmacy and PIM use are analysed for subgroups and modelled based on the results of XXX study.The XXX study found that 28% of older adults used at least one PIM and 59% had polypharmacy. Polypharmacy and PIM prevalence increased with age and was higher among people with lower education. 32% of PIM users were hospitalized in the last year compared to 21% of non-PIM users. The overall most frequently used PIM were pantoprazole or omeprazole (for a period longer than 3 months), ibuprofen (high dose for a period longer than 3 months) and ginko biloba leaf extract; however, the sequence changes according to sex, age group and income status. Analysis of medication use in XXX program is currently underway.Individual risk assessment of medication use in older adults must consider multimorbidity and socioeconomic vulnerability. Polypharmacy of prescribed medication reinforced by self-medication is strongly associated with PIM use, increasing hospitalization risk. Family doctors can play a crucial role in reducing PIM in older patients.A comprehensive and regularly performed medication review in family practice can optimize medication in older adults, enhance safety and health outcomes.