Polypharmacy: Scope of Practice and Role for Health & Well-being Coaches

Polypharmacy is defined, usually though not formally, as regular, concurrent use of five or more medications. Meeting this definition is relatively easy for older adults who, on average, take four daily medications.  15% of older adults are taking eight or more meds! 

This is not a problem confined to those over 65. The young and middle-aged often take prescription medicines to treat depression, pain-remediation, risk factor mitigation, and disease control.  We can easily imagine a patient with hypertension and diabetes having a daily management regimen exceeding five prescriptions. Over-the-counter medications can add to the medicinal pile-up as they may also interact with prescribed meds.

Polypharmacy is often necessary and appropriate to treat multiple chronic diseases.  However, it is also possible for polypharmacy to be inappropriate and result from years of medical treatment without regular, careful reevaluation of patient status.

The consequences of polypharmacy are many and can be seen at the systemic, societal, and individual levels. Excessive medication costs and greater hospitalization burden the healthcare system, while patient debilitation can strain families, friends, and communities. A patient can suffer from a multitude of adverse effects of medicines, ranging from loss of appetite to decreased interest in usual activities and potentially mental confusion. There is also danger in poor adherence to essential medications when so many pills are to be remembered and juggled daily.

Recognizing the adverse effects of polypharmacy is not easy because many of the signs and symptoms can be attributed to other aspects of illness and disease. Notwithstanding that, some adverse effects of polypharmacy can be sleeplessness, decreased alertness, GI problems, depression, and greater incidents of falls.  In fact, taking four or more medications is known to be associated with a greater likelihood of falling.

Health and well-being coaches (HWC) are impactful in helping people with multiple conditions improve their health. Coaches can also help patients take responsibility for adhering to their medication regimens.  Studies show that HWC can support a patient’s goals regarding medication adherence by facilitating coaching conversations that include discussion about a client’s medications.  The alert and caring HWC can encourage a patient to recognize the risks of polypharmacy and support the patient’s efforts to engage with their physicians on reducing these risks.  Coaches working with patients managing polypharmacy in clinical settings and integrated into patient care teams will need to acquire the knowledge and develop the skills to effectively support polypharmacy discussions with patients.  This can be accomplished on the job or in training programs consistent with the HWC scope of practice.

Patient-driven behavior change, as supported by the HWC, can lead to health improvements. Changing physical activity and diet patterns, loss in body weight, and improved mental outlook (e.g., reduced anxiety) can all change the need for prescription medications.  The vigilant HWC recognizes this possibility and supports patients' understanding that changing their lifestyle behavior can also affect their medication needs 

HWC's scope of practice must be carefully considered when assisting a client who is potentially dealing with the adverse effects of polypharmacy.  The HWC should not undertake responsibility for a client’s compliance with their prescriptions.  Instead, the coach should enable patients to be self-accountable for managing their medications.  The coach can be familiar with their clients’ prescriptions but not responsible for tracking them.  The National Board of Health and Wellness Coaches and the law are clear: unless authorized by license (e.g., MD, NP, PA), a HWC can never prescribe, adjust, or recommend any changes to a client’s medications.  Directing a client to alter medication can be a life-threatening action while also putting the HWC in a legally dangerous situation.

The HWC can help clients identify resources to increase their medication literacy and understand each of the medications they are taking.  HWC can collaborate in the development of the client’s plan for following their medication regimen.  And importantly, the HWC can support the clients’ preparation for visits (list of all meds, symptoms) with the prescriber. HWC promotes self- efficacy by encouraging clients to voice concerns, ask questions, and have conversations about medications with healthcare providers.  Empowering clients to care for themselves is a central role of the HWC. 

In summary, the HWC needs to operate within the HWC’s scope of practice while assisting clients who are negatively impacted by polypharmacy.  The HWC who is working with a patient with comorbidities needs to be effectively integrated within the patient’s health care team.  While a HWC has no role in medication prescription, if properly trained the HWC can effectively coach clients to understand potential adverse impacts of polypharmacy and to self-monitor themselves for such adverse effects. Through empowerment and referral to education and care coordination resources, the HWC can help clients in their medication optimization efforts.  The coach’s client-centered approach makes them a valuable ally in the healthcare team’s efforts to enhance patient well-being while mitigating the risks of polypharmacy.  On a broader scale, these efforts can help alleviate patient suffering, reduce healthcare utilization, and lower the overall costs associated with widespread polypharmacy in our healthcare system.

Bibliography

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National Board of Health and Wellness Coaches.  Scope of Practice.  https://nbhwc.org/scope-of-practice/

Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft D. Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review. BMJ Open. 2024 May 24;14(5):e081698. doi: 10.1136/bmjopen-2023-081698.

Varghese D, Ishida C, Patel P, et al. Polypharmacy. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532953/

Whitman STK, Westervelt K, Weinand RL, Sibold J, Thompson TL, O'Farrell KD, Wolever RQ. Health and Wellness Coaching in Clinical Care: A Call to Action. J Integr Complement Med. 2025 Oct 30. doi: 10.1177/27683605251392361

Wolever, R.Q. and Dreusicke, M.H., 2016. Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. BMJ Open Diabetes Research and Care, 4(1), p.e000201.