RESUMEN
Pharmacotherapeutic care of the elderly and psychiatric patients is complex and risky, because polypharmacy, the chronic use of five or more medications by a patient, is highly prevalent in these groups. Polypharmacy is a risk factor for medication related hospital admissions. The Dutch Health Care Inspectorate (IGZ) adopted 'improving care for the elderly' and 'improving medication safety' as spearheads. In order to provide input to IGZ enforcement policy, RIVM investigated the risks of polypharmacy as well as the measures that might limit these risks. This study shows that over- and undertreatment frequently occur. This may be caused by the fact that a physician sometimes does not know which medicines for a patient were prescribed, changed or stopped by other physicians. It was also found that psychiatric patients often experience side effects or interactions that are specific to psychiatric medicines, sometimes in combination with somatic medication. Various guidelines to improve medication safety are available, but several bottlenecks hamper the implementation, for example in the area of collaboration, direction and transfer of information on medication. But also ICT is insufficiently facilitating and physicians have too little knowledge of polypharmacy in the frail populations. The health care sector is taking various initiatives to remove bottlenecks. IGZ will from 2015 in all health care domains focus on four guidelines that describe the conditions for sensibly prescribing medication to frail people with polypharmacy.