IMPPP: Improving Medicines use in People with Polypharmacy in Primary Care


National Institute for Health (NIHR) Health Service & Delivery Research (HS&DR) Ref. 16/118/14

What is the research question?

Can we develop and evaluate an intervention to optimise medication use for patients with polypharmacy in a general practice setting?

What is the problem?

Prescribing medicines is one of the most important things doctors do to treat illness and improve peoples’ health. The UK population is steadily ageing and people often have more than one health problem. This means more people are taking multiple medicines, which is called polypharmacy. It is often necessary to help a person keep well, but polypharmacy can also cause problems such as side effects or confusion about exactly what medicines are to be taken when. We need to find ways of improving the use of medicines in people with polypharmacy so we can reduce some of these problems. However, there is no good scientific evidence to help health care professionals decide how to most effectively do this.

What is the aim of the research?

The aim of this project is to create an effective approach for improving the use of medicines in people with polypharmacy attending general practice.

We will develop a new approach (called IMPPP) to improve how we manage polypharmacy. IMPPP will improve how GP surgeries organise reviews of medicines for patients. It will encourage better care by providing GPs with training, payments, and information about how well their practice is performing. It will use a new computer program to help GPs and pharmacists make the right decisions about medicines. Patients’ concerns and wishes about their medicines will remain central. This research will provide us with valuable information about which people with polypharmacy might benefit most from having improvements made to their medicines, and tell us what approaches work best for improving the use of medicines in people with polypharmacy.

How will this be achieved?

Our project has 3 parts:

  1. Firstly, we will speak to health care professionals and patients with experience of a similar approach used in Scotland. We will use prescribing data gathered by the Scottish GP computer systems to help us understand which people with polypharmacy will benefit most from improved care. We will use this information to design the new IMPPP method, with the help of patients and other experts.
  2. Secondly, we will test IMPPP in 3 Bristol-based GP surgeries. We will interview individuals in these surgeries to find out about any problems with IMPPP so we can improve it.
  3. Thirdly, we will carry out a clinical trial in Bristol and Staffordshire. The trial will compare 27 surgeries using IMPPP to 27 surgeries using current, normal practice. We will check whether IMPPP results in improved medicines safety, less use of health services, and better quality of life and less burden of treatment for the patients involved. We will also check whether IMPPP is acceptable to patients and both doctors and pharmacists, and will find out the cost implications of IMPPP for the NHS.

Who is leading the research?

Dr Rupert Payne, Consultant Senior Lecturer in Primary Health Care, Centre for Academic Primary Care, Population Health Sciences, University of Bristol.

Further information:


For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.