Polypharmacy: Definition, Causes, Risk Factors, Consequences & Prevention
Definition of polypharmacy
WHAT IS #POLYPHARMACY??
POLYPHARMACY refers to the use of multiple medication by a patient – typically 5 or more , but definitions vary.The more drugs used to treat a patient, the greater the degree of pill burden.This increases the risk and probability of adverse effects. Many of these new adverse effects are themselves treated with additional medicines – and so the cycle continue.
The clinician needs to carefully assess the risk : reward ratio and establish whether the addition of more medicines is justified given the likely clinical consequences. Polypharmacy is mainly a problem of the elderly because they are plagued with chronic medical conditions.
Consequences of Polypharmacy
The advice to tell any healthcare provider you see all of the medications and supplements you are taking, prescription or over the counter, is critical. While a drug may be recommended to you because of a specific intended purpose, drugs do not act in isolation in your system. As such, everything you are taking must be considered when making treatment choices.
Polypharmacy poses several concerns:
Excessive known side effects, particularly for the elderly, as sensitivities to medication increase with age.
Additive side effects when several medications induce similar physical responses.
Dangerous drug interactions, which may produce new side effects not typically associated with either medication.
Diminished effectiveness of one medication due to the metabolic action of another medication.
Confusion with regard to medication use, resulting in missed doses, extra doses, or other errors.
Risk factors and Causes of Polypharmacy
Why It Occurs:
Polypharmacy is very common. Often, old people or patients with many health problems need to take several medications to control multiple medical conditions. While these medications, individually, may be warranted, there are times when the number of drugs prescribed for a given issue is more than is necessary.
There are a variety of other reasons polypharmacy can occur as well, including:
👉Prescribing cascades: If you have several health conditions, you may experience what is described as a “prescribing cascade,” in which you are given a prescription to counteract side effects of another medication or to counteract an interaction between two or more other prescribed medications.
👉Disconnected medical care: This is more likely to occur if you or your loved one is cared for by several healthcare providers, including specialists or practitioners who may only see you for a short period of time, such as during an urgent hospitalization. One healthcare provider may give you a prescription that compounds or counteracts the effect of a medication you already take, particularly if you are getting care at a different healthcare center than usual.
👉Pharmacy changes: If you fill your prescriptions at multiple pharmacies, none are likely to have a complete list of your medication regimen (unless you have visited multiple locations of a pharmacy chain).
Interactions between medications may go unnoticed when the combination would have raised a red flag if you were getting all of your prescriptions from the same place.
Prevention of Polypharmacy:
Polypharmacy can be managed as a team effort between healthcare providers, patients, and families.
What you can do (or help a loved one with):
👉Pick a point person: Be sure to select a primary care practitioner or a geriatrician who you are comfortable with and schedule regular appointments with this lead healthcare provider. Usually, when you see a specialist, your primary healthcare provider receives a consultation note, along with all new medication recommendations, from your specialist.
When you see your primary healthcare provider, he or she should know all of your medical problems, which other healthcare providers you see, and which medications you take. This healthcare provider can recognize signs and symptoms of polypharmacy and can discontinue redundant or unnecessary medications if you are taking any.
👉Keep track of medications: List out all of your medications and supplements, and review it regularly for necessary updates. Bring this list to all your appointments and show it to your care providers. Ask them to check the list for any possible complications and remember to discuss all of your medical symptoms, as some might be side effects of your medications.
👉Talk to your pharmacist: Pharmacists are trained to look for drug interactions and other problems, but they can only do that if they have all your information. Hand them your prescription list and ask them to look it over. This is especially important if you get your medications from more than one pharmacy. Consultations are free.
Don’t stop your medications without approval from your doctor. You might be prescribed more than one heart or diabetes medication because one is not enough to control your condition. While polypharmacy can be harmful, medication adherence is important too.
Healthcare systems are continuously looking for ways to play their part. Systemic solutions include:
👉Strict recording keeping and updating: Tracking of prescriptions can allow your medical team to find your medication list more easily. This type of list may be generated within a medical clinic or hospital system, not between systems.
“Smart” systems that recognize and flag dangerous medication interactions and redundant prescriptions
Patient-friendly information describing the risks and benefits of each medication to be provided along with prescriptions.
Guardian Pharmacy Ltd