Unit 4 lec

• Polypharmacy is the concurrent use of multiple medications, often defined as the routine use of five or more medications
• Polypharmacy includes over-the-counter, prescription, and traditional and complementary medicines used by a patient
• Appropriate polypharmacy criteria:

  • Medicines are prescribed for specific therapeutic objectives agreed with the patient
  • Therapeutic objectives are being achieved or have a reasonable chance of being achieved
  • Medication therapy is optimized to minimize the risk of adverse drug reactions (ADRs)
  • The patient is motivated and able to take all medicines as intended
• Inappropriate polypharmacy occurs when one or more medicines are prescribed that are not needed, no longer needed, or fail to achieve therapeutic objectives
• Vulnerable patient groups to polypharmacy:

  • Older patients above 65 years
  • Patients living in care homes
  • Susceptible to drug-drug interactions, falls, ADRs, cognitive impairment, non-adherence, and poor nutritional status
• Factors increasing polypharmacy prevalence:

  • Global demographic shift towards an older population
  • Multimorbidity increases with age
• Medication-related harm in polypharmacy:

  • Polypharmacy at transitions of care can lead to medication discrepancies and adverse drug events
  • Polypharmacy in care homes may result in inappropriate prescriptions
  • Nonprescribed medications like OTC drugs can interact with prescribed medications
  • Traditional and complementary medicine use should be considered for potential interactions
• Medication review in polypharmacy:

  • Evaluates effectiveness and risk-benefit ratio of medication treatment options
  • Structured evaluation to optimize medicines use and improve health outcomes
  • Pharmacist-led reviews reduce hospital admissions and medication-related problems
• Assessing risks and benefits:

  • Number Needed to Treat (NNT): average number of patients needed to be treated for one to benefit
  • Number Needed to Harm (NNH): average number of people taking a medication for one adverse event to occur
  • NNT/NNH ratio should be considered in decision-making
• Medication review process in polypharmacy:

  • Should engage with the patient and align intentions with prescribers' goals
  • Step-by-step approach to conducting a patient-centered medication review
• Therapeutic objectives include achieving symptom control, biochemical/clinical targets, and preventing disease progression/exacerbation
• To identify the need for adding/intensifying medication therapy, assess if therapeutic objectives are being achieved
• Temporary indications, higher-than-usual maintenance doses, and limited benefit for the indication target or particular patient under review are reasons for using certain medications
• Safety considerations involve assessing adverse drug reactions, patient knowledge on managing illness, drug interactions, monitoring mechanisms, and risk of accidental overdosing
• Cost-effectiveness of therapy can be evaluated by identifying unnecessarily costly medications and considering more cost-effective alternatives
• Patient-centeredness involves assessing if the patient is willing and able to take medication as intended, understanding the outcomes of the review, and tailoring medication changes to patient preferences
• Deprescribing involves tapering, stopping, discontinuing, or withdrawing drugs to manage polypharmacy and improve outcomes
• Health systems approach to polypharmacy includes encouraging patients to disclose all medications, prioritizing medication reviews for certain groups, and raising awareness among healthcare professionals
• Systems and practice of medication safety involve addressing different components like patients, healthcare organizations, policy-makers, and regulators to ensure optimal and sustainable use of medicines
• Monitoring and evaluation in polypharmacy focuses on distinguishing between inappropriate and appropriate polypharmacy based on patient and therapy needs, not just the number of medications used