Letters Treating multiple chronic conditions

Guidance for prescribing in frail adults is now available

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2136 (Published 21 March 2012) Cite this as: BMJ 2012;344:e2136
  1. Findlay M Hickey, lead pharmacist1,
  2. Martin Wilson, consultant physician2
  1. 1Raigmore Hospital, Inverness, IV2 4UG, UK
  2. 2Mid Highland CHP, Dingwall, IV15 9UG, UK
  1. findlay.hickey{at}nhs.net

This article strikes at the heart of a core problem in modern healthcare.1 Despite excellent single pathology guidelines from organisations such as the Scottish Intercollegiate Guidelines Network and the National Institute for Health and Clinical Excellence, we lack guidance and advice on how to systematically approach problems of comorbidity and frailty. In NHS Highland, a group of doctors and pharmacists from primary and secondary care has produced a guideline that attempts to give useful guidance on how to deal with medication problems raised by frailty and multiple comorbidities.2

The guideline provides guidance on how to make safe and sensible decisions on prescribing in two often overlapping situations, where extra thought and care are needed—firstly, when patients are taking or may need to take multiple drugs, and secondly, when a patient is frail in a medical sense. Frailty is used to describe a state where patients have reduced ability to withstand illness without loss of function.

This is happening right now in the Highlands, and we have been heartened by the interest and enthusiasm of local GPs and colleagues in other parts of Scotland. This is not research but an attempt to implement a policy in response to what research has shown. We see this as an opportunity to improve the quality of care, reduce the burden of iatrogenic disease, and redress the balance of care with regard to prescribed drugs in the patient’s favour.


Cite this as: BMJ 2012;344:e2136


  • Competing interests: None declared.