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At least 325 records · Page 18Linked to original sources
PubMed2003

Polypharmacy and medication adherence in patients with type 2 diabetes.

OBJECTIVE: To determine medication adherence and predictors of suboptimal adherence in a community cohort of patients with diabetes and to test the hypothesis that adherence decreases with increased number of medicines prescribed. RESEARCH DESIGN AND METHODS: A total of 128 randomly selected patients with type 2 diabetes from a single community health center responded to a pharmacist-administered questionnaire regarding medication use. Survey data were linked to clinical data available from the electronic medical record. We assessed self-reported adherence rates for each diabetes-related medicine, barriers and attitudes regarding medication use, and HbA(1c), total cholesterol, and blood pressure levels. RESULTS: Patients were taking a mean of 4.1 (+/-1.9) diabetes-related medicines. The average 7-day adherence was 6.7 +/- 1.1 days. Total number of medicines prescribed was not correlated with medication adherence. Adherence was significantly lower for medicines not felt to be improving current or future health (6.1 vs. 6.9 days out of 7, P < 0.001). Among patients on three or more medicines, 71% (15 of 21 patients) with suboptimal adherence were perfectly adherent with all but one medicine. Side effects were the most commonly reported problem with medication use. Of 29 medicines causing side effects that interfered with adherence, 24 (83%) did so for >1 month, and only 7 (24%) were reported to the patient's primary care physician. CONCLUSIONS: In this sample, patients reported very high medication adherence rates regardless of number of medicines prescribed. Among patients on multiple medicines, most patients with suboptimal adherence were perfectly adherent to all but one medicine. Unreported side effects and a lack of confidence in immediate or future benefits were significant predictors of suboptimal adherence. Physicians should not feel deterred from prescribing multiple agents in order to achieve adequate control of hyperglycemia, hypertension, and hyperlipidemia.

Adult↗
PubMed1993

Rational polypharmacy in schizophrenia.

Approximately 10 to 30% of patients with schizophrenia show poor response to neuroleptics alone. An initial evaluative and treatment approach to these patients is outlined, and the literature on adjunctive treatments, which seek to augment neuroleptic effects, is reviewed. The greatest evidence for efficacy has been shown for lithium, benzodiazepines, carbamazepine, reserpine, and electroconvulsive therapy, although individual patients may also respond to propranolol, clonidine, valproic acid, and L-dopa. Antidepressants may also be useful for treating comorbid depression in nonacutely psychotic patients. One general theme is that no one adjunctive treatment benefits all patients; indeed, only a minority of patients responds to any given agent. Therefore, the choice of specific treatments is best guided by the clinical characteristics of the individual patient. These observations raise the possibility that subgroups of schizophrenia exist; delineation of differences in clinical response to biochemically distinct agents may help elucidate such underlying differences between patient groups.

Antidepressive Agents↗
PubMed1993

Rational polypharmacy in the treatment of mood disorders.

Increasing awareness of treatment resistance and the emergence of tolerance on once effective medications have facilitated acceptance of a variety of novel drug combination treatment strategies. Although clinical practice is based for the most part on a literature that is still seriously lacking in well-controlled and methodologically rigorous studies, the risk-benefit ratio in most cases seems acceptable if a clear understanding of the possible therapeutic and adverse interactions on the part of both the physician and the patient prevails. Historically, drug combinations have emerged out of serendipity, but increasingly, theories of complimentary drug action serve a heuristic propose in guiding clinical research efforts, and in testing the purposed mechanisms of actions for each of the drugs separately.

Antidepressive Agents, Tricyclic↗
PubMedDate not supplied

MAC prophylaxis in the era of polypharmacy.

In the advanced stages of AIDS, patients are increasingly susceptible to disseminated Mycobacterium avium-intracellulare (MAC) infection, causing significant morbidity and mortality. It has been shown that prophylaxis against this infection is effective in reducing the incidence as well as the symptoms of MAC. Although chemoprophylaxis against MAC is a standard recommendation, it is not always carried out due to a variety of reasons. Several agents are now approved for this purpose, adding to the complexity of the decision to start the prophylaxis. This article reviews the need for prophylaxis against MAC, and considers the different agents available, with the aim of helping readers come to an informed decision about starting MAC prophylaxis in their patients. This issue will be of rising importance with the effective prevention of other opportunistic infections in patients with advancing immune deficiency.

AIDS-Related Opportunistic Infections↗
PubMed1976

Polypharmacy.

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Anesthetics↗