American Society of Health-System Pharmacists

View all recommendations from this society

June 1, 2017; updated July 28, 2021

Do not prescribe or indefinitely continue medications for patients on five or more medications, without a comprehensive medication review including prescription and over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements can be discontinued and assure all medications to be taken by the patient are optimized for the patient’s specific medical and social conditions.

Studies have shown that patients taking five or more medications often find it difficult to understand and adhere to complex medication regimens. Comprehensive Medication Management services where medication-use experts review all medications and medical conditions in collaboration with patients, their healthcare team, families, and caregivers; to ensure treatment plans are optimal, all medications are needed, and the plan respects patients’ beliefs, values, autonomy, and agency; should be conducted at periodic intervals appropriate for the patient, or at a minimum annually.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

A task force made up of pharmacists from all practice settings was formed. The task force was oriented to the criteria used to establish Choosing Wisely lists and already established recommendations. Based on this information and on their knowledge of how medications are prescribed, dispensed, and administered, the task force developed an initial list of recommendations. Over time this list was vetted, evaluated, researched, and referenced. Through a consensus process over time the list was prioritized down to a total of five recommendations. This list was approved by the ASHP Board of Directors.

Sources

Maher RL, et al. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014; 13: 57-65. dx.doi.org/10.1517/14740338.2013.827660

Gorard, DA. Escalating polypharmacy. QJM 2006; 99 (11): 797-800. doi.org/10.1093/qjmed/hcl109

Lehnbom, EC, et al. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother. 2014;48:1298-1312.

Shane, R and Abramowitz, PW. Choosing Wisely: Pharmacy’s role in effective use of medications. Am J Health-Syst Pharm. 2015; 72:1529-30. doi.org/10.2146/ajhp150324.

The Patient Care Process for delivering Comprehensive Medication Management (CMM): Optimizing Medication Use in Patient-Centered, Team-Based Care Settings. CMM in
Primary Care Research Team. July 2018. Available at http://www.accp.com/cmm_care_process

ASHP Practice Advancement Initiative 2030: New recommendations for advancing pharmacy practice in health systems. Am J Health-Sys Pharm. 2020; 77:113-122.