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PubMed2007

[Polypharmacy, compliance and non-prescription medication in patients with cardiovascular disease in Germany].

BACKGROUND AND OBJECTIVE: The expenses of health insurances are continuously raising. With implementation of evidence-based medicine resulting in polypharmacy, compliance is decreasing and patients as well as physicians are facing unintentional drug interactions. Furthermore the arbitrary use of additional drugs apart from prescribed medication has to be considered. The objective of this study was to analyse polypharmacy, compliance and utilisation patterns for non-prescription medications (OTC) in patients with cardiovascular diseases. METHODS: 100 patients with cardiovascular diseases (45 women, 55 men, 58 - 87 years) were interviewed using a questionnaire. The compliance was determined by the Morisky-Score. RESULTS: 78 % of the patients received more than four pills every day (median 8.34). Most common products were beta-blockers (89 %), ACE-Inhibitors/Sartans (69 %) and aspirin (65 %). Only 52 % of the patients knew the indications of their medication. Although 83 % of the patients claimed to be absolutely compliant concerning their medication, the Morisky-Score revealed a high compliance only in 52 %. The compliance decreased significantly if the number of prescribed medication increased to more than four pills a day. 48 % of the patients took regularly non-prescription products, 35 % more than three additional products daily. Most commonly multivitamins, minerals, herbals and non-steroidal anti-inflammatory drugs were used. This non-prescription medication did not affect the compliance of the patients. CONCLUSIONS: Polypharmacy with more than four pills daily leads to a lower compliance and can therefore influence the implementation of guideline-medicine. Non-prescription medication is widely used and should be considered because of their potential side-effects and drug interactions.

Adrenergic beta-Antagonists↗

PubMed2000

Polypharmacy and hospitalization among older home care patients.

BACKGROUND: One of the major goals of home care is the prevention of hospitalization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among home care patients older than 65 years. METHODS: A retrospective chart review of 833 discharged older home care patients was performed. These patients were consecutive discharges from a single home care agency who either (a) returned to independent self-care or care of the family (S/F Care group) or (b) were admitted to the hospital (Hospitalized group). Medication assessment within these two groups included total number of medications (prescription and nonprescription); degree of polypharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or more medications); and prevalence for different types of medications, including different types of inappropriate medications. Inappropriate medications were designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric pharmacology and has been utilized in other studies. Student's t test was used for continuous variables and chi-square test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group (p <.05). For comparisons of types of medications, p < .01 was used for significant differences, because of the high number of comparisons made. RESULTS: Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (S/F Care group) and 189 (22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of medications (mean +/- SD: 6.6+/-3.9 vs 5.7+/-3.4, p = .004), and had a higher percentage of patients taking 7 or more medications (46% vs 26%, p = .002) and 10 or more medications (21% vs 10%, p = .005), but not 5 or more medications. Only three types of medications were more commonly used among patients in the Hospitalized group than among patients in the S/F Care group: clonidine (4.2% vs 1.1%, p = .004); mineral supplements (23.8% vs 14.8%, p = .003); and metoclopramide (5.8% vs 2.0%, p = .006). The Hospitalized group had a lower percentage of patients taking inappropriate medications than did the S/F Care group (20% vs 27%, p = .040), but none of the types of inappropriate medications was used more often in either group. CONCLUSIONS: This study shows a relationship between high levels of polypharmacy and hospitalization. Although it cannot be determined from this study whether a higher number of medications was an indicator of sicker patients at risk for hospitalization, or whether a higher number of medications might have directly led to hospitalization, polypharmacy should still be considered a marker for older home care patients for whom prevention of hospitalization is the goal.

Activities of Daily Living↗

PubMed2005

Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription.

BACKGROUND: Despite extensive research and recommendations regarding the optimal prescription of antipsychotic drugs, polypharmacy and excessive dosing still prevail. AIMS: To identify the factors associated with the polypharmacy and excessive dosing phenomena. METHOD: We studied 139 patients with schizophrenia, in 19 acute psychiatric units in Japanese hospitals, who were due to be discharged between October and December 2003. We examined patient characteristics, nurses' requests, and psychiatrists' characteristics and perceptions of prescribing practice and algorithms. RESULTS: Polypharmacy and excessive dosing were observed in 96 cases. Logistic regression analysis revealed that the use of multiple medications and excessive dosing were influenced by the psychiatrist's scepticism towards the use of algorithms, nurses' requests for more drugs and the patient's clinical condition. CONCLUSIONS: Educational interventions are necessary for psychiatrists and nurses to follow evidence-based guidelines or algorithms.

Adult↗

PubMed2002

Problems of polypharmacy.

BACKGROUND: Polypharmacy is common in the management of many conditions. The aim of good prescribing should be to avoid unnecessary polypharmacy. OBJECTIVE: To describe how the World Health Organisation Guide to good prescribing provides a structure for improving prescribing and avoiding polypharmacy. DISCUSSION: Therapeutic goals should be individualized in order to use only those medicines that achieve desirable outcomes for the individual patient. Nonpharmacological approaches should be reviewed as these can result in better patient outcomes and can reduce the dose and the number of medications used. Patients should be monitored for not only the effects but also the adverse effects of prescribed medications. If an adverse reaction is found, the therapeutic approach should be reassessed and alternative approaches or medications triald rather than adding another medication to ameliorate the adverse effects of the first.

Cardiovascular Diseases↗

PubMed2002

Polypharmacy in palliative care: can it be reduced?

INTRODUCTION: Minimising polypharmacy is important A study was done to see if this was achievable in patients under palliative care and compares the types of drugs used before and after referral. METHOD: Medication charts of 345 patients seen in June to August 2000 in hospital-based palliative consultation service, home care and hospice, were reviewed. The drugs used were recorded on two occasions--before referral and two weeks after or just before discharge from hospital or hospice, provided that death was not imminent. RESULT: The median number of drugs used was five, before and after referral. Analgesics and laxatives were frequently used in palliative care (60.3% and 60% respectively). The commonest analgesic was opiates (41.2% before and 47.8% after referral). Only the difference in laxative usage (50.4% prior to referral and 60% after) was statistically significant at p<0.01. 40.3% of the patients had an increase in the number of drugs after referral and 45.3% of them had addition of laxatives, compared to less than 30% for other drugs. A significantly higher proportion of patients (24.6% versus 18%) were on two or more drugs for constipation after referral. CONCLUSIONS: Reducing polypharmacy in palliative care is often difficult. There was higher awareness of bowel habits and treatment of constipation amongst those involved in palliative care. In addition to reviewing the use of some drugs, other measures such as patient education may be useful in minimising polypharmacy.

Aged↗

PubMed2004

The practice of polypharmacy involving herbal and prescription medicines in the treatment of diabetes mellitus, hypertension and gastrointestinal disorders in Jamaica.

The interference in the metabolism of a drug by another drug, food or other foreign chemical is commonly observed and often leads to clinically significant adverse drug reactions. In Jamaica, there is an extensive use of natural products as medicines, although there is little information on whether natural medicines are used along with prescription medicines, which might increase the likelihood of drug adversities. This current pilot survey was initiated to gain information on the prevalence of such polypharmacy practices. Two concurrent surveys were carried out in Kingston (an urban parish) and Clarendon (a rural parish) in 743 patients above age 14 years with diabetes mellitus, hypertension and gastrointestinal disorders of persons who visited health centres and pharmacies. Patrons visiting these places at various times of the day were informed of the nature of the questionnaire and willing participants with the above disease conditions and who were on prescription medicines were included in the survey. The results indicated that 80% of the respondents reported combining natural products in their treatment along with prescription medicines, with only 13% of those patients informing their physicians of such practices. Such polypharmacy practices were independent of the type of disease among both males and females and was statistically most prevalent (p < 0.001) in the 47-57-year age group. There was a significant association (p < 0.001) between such treatment practices and place of residence with 92% of the rural community engaging in polypharmacy but 70% of the urban did likewise. Therefore, being aware of the prevalence of multiple therapy practices would be especially useful when designing a pharmaco-vigilance system.

Adolescent↗

PubMed2005

[Is smoking a determinant of polypharmacy among elderly subject?].

Polypharmacy is a risk factor for functional impairment in elderly subjects. The description of its determinants seems to be important as the tool for the protection against disability. The aim of the study was to answer the question whether cigarette smoking is a determinant of polypharmacy in advanced aged. The analyzed sample consisted of 150 elderly inhabitants, 93 women of different cities in western Poland (mean age: 72.3+/-6.7 years). Based on specially prepared questionnaire cigarette smoking habit was analyzed as well as the quantitative and qualitative aspects of pharmacotherapy. All studied subjects were divided into two groups: group A former and current smokers (80 subjects, 34 women) and group B - non-smokers (70 subjects, 59 women). The analyzed subjects consumed 6,0+/-3,2 drugs on average (4.9+/-2.5 prescribed drugs and 1.2+/-1.5 over-the-counter. As far as the number of drugs is concerned there was no difference between group A and group B (6.2+/-3.4; 5.1+/-2.6 and 1.0+/-1.5 vs. 5.9+/-3.0; 4.6+/-2.5 and 1.3+/-1.6, respectively). Also, the qualitative analysis was comparable. In conclusion, in analyzed subjects cigarette smoking was not a determinant of polypharmacy. Further studies are necessary to prove this observation and to explain its causes.

Aged↗

PubMed2006

Effects of a polypharmacy edit and reduced quantity limits on the utilization of triptans and overall costs in an integrated health system.

On January 1, 2004, Intermountain Healthcare Health Plans implemented a polypharmacy edit and reduced the quantity limits of triptans to minimize the risks associated with triptan polypharmacy. The intervention covered one oral triptan brand per month and allowed one alternate formulation, limited monthly oral triptan quantities, and recommended use of prophylactic medication. During 2003, the prescription count per quarter for triptans increased from 4,816 to 5,359. The number of utilizing members increased from 2,659 to 2,781 over the course of the year. Total ingredient cost for fourth-quarter 2003 was dollar 932,950. For first-quarter 2004, the prescription count was 4,131 (used by 2,423 members) at a total ingredient cost of dollar 583,988. Fourth-quarter 2004 utilization was 4,763 prescriptions, 2,719 members, and dollar 700,534 total ingredient cost. The total triptan spend was dollar 872,718 lower during 2004 compared with 2003. Total medical claims remained constant over the two-year period for members who had a history of at least one triptan during that time. Educating members and health care professionals about the appropriate use of triptans can improve outcomes, and reevaluation of polypharmacy edits and quantity limits based on evolving clinical data improves the appropriate use of triptans.

Antidepressive Agents, Second-Generation↗

PubMed1997

Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients.

Urinary incontinence, delirium and polypharmacy are common, challenging problems encountered in elderly patients. Review of the literature shows that these conditions are interrelated. For example, polypharmacy can lead to delirium, which, in turn, can lead to urinary incontinence. The drugs prescribed for urinary incontinence can precipitate delirium or contribute to polypharmacy. The underlying causes for these problems in elderly patients are frequently complex, and management in turn must often be multifactorial. The occurrence of these problems should lead to careful evaluation followed by thoughtful, responsive treatment. Brief updates are given with recommendations for management directed at primary care physicians.

Adrenergic alpha-Agonists↗

PubMed1985

Reduction of polypharmacy in epileptic patients.

An attempt was made to reduce polypharmacy in 90 epileptic patients. All patients received their original drug regimen for at least six months and were followed up for a minimum of 16 months after reduction of polypharmacy. In 72 patients (80%), the average number of drugs administered was reduced from 2.75 to 1.49. In 39 of these (54%), a reduction was made to single drug therapy. Either no change or an improvement in seizure control was observed, and side effects decreased in many patients. In 18 patients (20%), medications could not be withdrawn. In nine of these, another drug was required for seizure control. In the remaining nine, more frequent seizures necessitated a return to the previous regimen. The critical variable predicting unsuccessful reduction of polypharmacy was the presence of multiple concurrent seizure types.

Adult↗

PubMed2006

[Polypharmacy in the treatment of schizophrenia].

Current standards for the pharmacological treatment of schizophrenia favour antipsychotic monotherapy. Most atypical antipsychotics developed in recent years meet the statutory requirement of being at least as effective as Haloperidol. Nevertheless, pharmacoepidemiological data show an increase in polypharmacy. The importance of the studies is underlined by the fact that 40 - 50 % of schizophrenic inpatients and up to 90 % schizophrenic outpatients receive antipsychotic combination therapies. Treatment resistance, reduction of dose-related side effects caused by antipsychotic monotherapy or the effect on concomitant symptoms of schizophrenia, such as comorbid depression, might justify combination therapy or augmentation strategies. Apart from the high costs, polypharmacy is associated with reduced patient compliance and an increased risk of undesired pharmacological effects. Since polypharmacy is increasingly common further educational measures in psychopharmacology should be getting more attention. Due to the very small number of controlled studies that exist at present this report will focus on case reports of the most frequent as well as some of the lesser prescribed combination therapies. Finally, conclusions will be discussed in relation to therapy recommendations.

Antidepressive Agents↗

PubMedDate not supplied

Polypharmacy and the elderly.

Polypharmacy is the concurrent use of several different medications used by the same individual, which in some cases can lead to drug-drug interactions. Elderly patients often are faced with polypharmacy when they have multiple disease processes. Declining organ function, as part of the normal aging process, adds to the problem of adverse drug effects in this population. To minimize polypharmacy, prescribers aim to treat multiple disease conditions with a single agent if possible. Pharmacists can often help in drug selection, if given a set of criteria. This article is intended to help infusion professionals provide safe medication treatment by understanding how aging organ systems and medications affect the elderly.

Aged↗

PubMed1990

Reducing polypharmacy in the elderly. A controlled trial of physician feedback.

A prospective, controlled trial to reduce polypharmacy in patients 65 years or older was carried out in the residents' clinic of a teaching hospital. Of 272 elderly patients surveyed, 89 (33%) were taking five or more prescription drugs. Recommendations to discontinue medications or to simplify regimens were formulated for 79 polypharmacy patients. Compared to 41 controls, the 38 patients whose physicians were informed of the recommended changes demonstrated a small but significant reduction in the mean number of drugs, the complexity, and the cost of their regimens. Physicians complied with eight (100%) of eight recommendations to simplify a dosage schedule, eight (62%) of 13 recommendations to substitute a new drug for the old one, and only eight (40%) of 20 recommendations to stop a medication (P = .04). Noncompliance usually resulted from patient refusal or from medications being prescribed by another provider. Whereas feedback to the primary physician is beneficial, more substantial reductions in outpatient polypharmacy may require overcoming patient barriers and limiting the number of prescribing physicians.

Aged↗

PubMed1985

An improvement in cognitive function following polypharmacy reduction in a group of epileptic patients.

18 epileptic patients on polypharmacy were assessed, using a battery of psychometric tests including the Wechsler Adult Intelligence Scale, Benton Visual Retention Test and Alertness and Concentration tests. The same patients were reassessed one year later following a trial to reduce their polypharmacy. The results for 12 patients whose treatment was reduced to monotherapy were statistically analysed, using the Wilcoxon Matched Pairs Test. Significant changes were found on a number of test scores which included Full Scale WAIS I.Q., W.A.I.S. Performance I.Q., Digit Symbol, Block Design and Object Assembly, Benton Visual Retention Test Error Score and Concentration Test Score. The other tests showed no improvement over baseline. The results point to the improvement in some areas of cognitive function which follows a reduction in polypharmacy to monotherapy.

Adult↗

PubMed1979

Reduction in polypharmacy for epilepsy.

A two-year prospective study of 40 adult outpatients with chronic epilepsy was carried out in which blood drug concentrations were monitored, and anticonvulsant polypharmacy was reduced to treatment with a single drug in 29 patients (72%). In the year after the reduction of treatment the control of seizures was improved in 16 patients (55%), unchanged in eight(28%), and worse in five (17%). Mental function was improved in 16 (55%). The main reason for failure to reduce to or maintain treatment with a single drug was exacerbation of seizures during the difficult withdrawal period, especially in patients with frequent seizures, taking several drugs, or with additional neuropsychological handicaps. It is more difficult to reduce polypharmacy than to avoid it in the first place. Polypharmacy may sometimes aggravate control of seizures.

Adolescent↗

PubMed2006

Predictive factors for polypharmacy among child and adolescent psychiatry inpatients.

BACKGROUND: Aim was to determine the predictive factors for polypharmacy among inpatient children and adolescents with psychiatric disorders. METHODS: Blinded, case-note review of children and adolescents with ICD 10 diagnosis of psychiatric disorders on psychotropic medication was conducted. Data on demography, illness, and treatment was analyzed with univariate and multivariate techniques. RESULTS: Proscribing non-pharmacological interventions (OR = 4.7) and pro re nata medication (OR = 3.3), increased the risk of polypharmacy. Prescribing physical restraint reduced the risk of receiving multiple medications (OR = 0.3). CONCLUSION: Proscribing non-pharmacological interventions, pro re nata medication and physical restraints increased polypharmacy.

Journal Article↗

PubMed2000

Polypharmacy and non-compliance in the hypertensive elderly patient.

BACKGROUND: Elderly patients are major consumers of prescription and nonprescription medications and the proper use of these agents can lead to more cost-effective strategies in reaching optimal health. The use of medications for the treatment of multiple co-morbid conditions in a single patient increases the risks of polypharmacy and non-compliance and raises the burden on the health care system and society. OBJECTIVES: To analyse the extent and nature of total and anti hypertensive, polypharmacy the most prevalent groups of drugs, the compliance rate and the costs related to polypharmacy in the hypertensive elderly. METHODS: A descriptive cross-sectional study was made of sixty-nine patients 65 years of age or older on follow-up for arterial hypertension at a central hospital in Lisbon. The study protocol consisted of a questionnaire performed by the physician. We calculated the monthly amount of individual prescription expense, after cost reduction from social insurance. RESULTS: The patients used an average of 4.4 prescribed medications with a corresponding average of 6.4 pills per day. Drug use was greater in women than men. Hypertensive therapy involved a mean of 2 drugs. Antiplatelet drugs, coronary vasodilators, bezodiazepines, glucose regulators and hypolipidemic agents were the other major groups of drugs. Non-compliance was identified in only 14% of the patients. The average of individual prescription expenses was 5,076 Portuguese escudos (PTE) per month, of which 2,226 PTE was the average cost of antihypertensive agents. CONCLUSIONS: With this study we were able to show the extent of poly-pharmacotherapy in a population of hypertensive elderly patients. We found a high rate of compliance, although the costs were frequently high.

Aged↗

PubMed1991

Polypharmacy in geriatric patients.

Although research-based information concerning geriatric polypharmacy is lacking, available data suggest possible causes, health risks, and areas for intervention. Nursing home residents are more likely to be recipients of unnecessary and excessive drugs than community-dwelling elderly. Polypharmacy can lead to increased adverse drug reactions, drug interactions, and medication errors. In the future, there will be single drug therapy for conditions now requiring multiple drugs, but improved diagnosis of disease could lead to persons receiving additional, appropriate drugs for these health problems. Informed patients collaborating with knowledgeable prescribers and those dispensing and administering their medications may be able to reduce the number of drugs they are taking. More research is needed to identify methods that promote safe self-medication behavior and better drug use in nursing homes. Health risks associated with polypharmacy and the escalating costs of medications require that nurse participation in ensuring that the elderly receive only necessary and effective drug treatment.

Aged↗