{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:55:56Z","timestamp":1790297756900,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,19]],"date-time":"2025-10-19T00:00:00Z","timestamp":1760832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIHR Applied Research Collaboration NW London"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Polypharmacy is typically seen as an unavoidable consequence of multimorbidity and aging, with clinicians addressing complex medication lists unsystematically. In this perspective, we argue that polypharmacy should be managed as a chronic condition. Like diabetes or hypertension, for example, the medication burden shows persistence, progression in its absence despite active management, predictable complications (such as falls, delirium, renal injury, functional decline), and a need for structured surveillance. We introduce a pragmatic diagnostic framework that moves beyond pill counts to modality-agnostic, regimen-level risk across prescribed and non-prescribed medicines. Diagnosis rests on prolonged exposure, composite burden indices (e.g., anticholinergic\/sedative load), medication-related complications or prescribing cascades, and the need for a planned review. As biologics, gene therapies and long-acting formulations can lower tablet numbers while increasing monitoring, administration, and interaction complexity. We treat polypharmacy as cumulative pharmacodynamic and operational burden. We advocate stage matched care with unique, functional aims\u2014decreasing the harmful burden instead of mass deprescribing\u2014and position a structured medication review as the standard for polypharmacy with support from pharmacists, shared decision making, and safety netted taper plans. The framework fosters patient-centred care, embedding continuity and equity, and outlines a concise outcome set that integrates pharmacometric measures with patient-reported function and treatment burden. At the systems level, the framework enables registries, recall systems, decision support, and audit\/feedback mechanisms to shift from sporadic medication list clean-up to a structured, measurable long-term program. Redefining polypharmacy in this way aligns clinical practice, education, and policy with real-world evidence, fostering a cohesive pathway to safer, streamlined, and more patient-centred care in community settings.<\/jats:p>","DOI":"10.3390\/jcm14207388","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T12:27:29Z","timestamp":1760963249000},"page":"7388","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Polypharmacy as a Chronic Condition: A Diagnostic Mindset for Safer and Smarter Care"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6914-7401","authenticated-orcid":false,"given":"Waseem","family":"Jerjes","sequence":"first","affiliation":[{"name":"Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, 90 Wood Ln, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, Faculty of Medicine, Imperial College London, 90 Wood Ln, London W12 0BZ, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101811","DOI":"10.1016\/j.arr.2022.101811","article-title":"Prevalence and health outcomes of polypharmacy and hyperpolypharmacy in older adults with frailty: A systematic review and meta-analysis","volume":"83","author":"Toh","year":"2023","journal-title":"Ageing Res. 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