When a patient walks into a clinic, receiving a prescription is supposed to be the first step toward healing. But what happens when that single visit ends with a prescription for five, eight, or more than ten different drugs at once? In low- and middle-income countries like Nigeria, where health insurance covers only a fraction of the population and healthcare is paid almost entirely out-of-pocket, taking multiple medications can transform a routine health check into a devastating financial crisis.

Our team set out to investigate this precise dilemma at Offa Specialist Hospital in Kwara State, Nigeria. We wanted to know: how widespread is polypharmacy in a secondary healthcare setting, and what does it actually cost the patients on the receiving end?

The Dual Realities: Prescription Records vs. Daily Survival

To get the full story, we combined two research perspectives: a retrospective review of 2,000 prescriptions and a prospective survey of 100 patients and 50 healthcare professionals. 

The Scale of the Problem: Over 37% of reviewed prescriptions met the criteria for polypharmacy (5 or more medications), with 12% involving "excessive polypharmacy" of 10 or more drugs. The average prescription contained 4.8 drugs. 

The Cost Barrier: Among surveyed patients, 37% spent over ₦20,000 per month on drugs, with an average expenditure of ₦18,600. For 79% of patients, these costs represented a major financial burden.

Dangerous Compromises: High costs forced 66% of patients to skip doses, reduce medication intake, or delay purchases. Additionally, 78% depended on financial help from family and friends just to pay for their prescriptions. 

Bridging the Gap: What Healthcare Providers See

The study revealed an overwhelming consensus among clinicians. Every single healthcare provider surveyed (100%) agreed that polypharmacy drives up treatment costs, and 84% noted that they frequently care for patients taking five or more medications. Crucially, 72% of providers recognized that some prescribed medications could be safely reduced through structured medication reviews. 

Our findings underline an urgent need to rethink prescribing habits. Addressing polypharmacy isn't just a clinical goal to avoid adverse drug interactions—it is an economic lifeline for patients navigating out-of-pocket healthcare. Integrating routine medication reviews, strengthening clinical pharmacology collaboration, and expanding universal health coverage are critical steps to ensuring that treating an illness doesn't cause a financial crisis.

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