Polypharmacy: Difference between revisions
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'''Polypharmacy''' is defined as "the use of multiple drugs administered to the same patient, most commonly seen in elderly patients. It includes also the administration of excessive medication."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=polypharmacy |title=Polypharmacy |accessdate=2007-12-15 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> Polypharmacy hinders compliance | '''Polypharmacy''' is defined as "the use of multiple drugs administered to the same patient, most commonly seen in elderly patients. It includes also the administration of excessive medication."<ref name="title">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=polypharmacy |title=Polypharmacy |accessdate=2007-12-15 |author=National Library of Medicine |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote=}}</ref> Polypharmacy hinders [[patient compliance]] with medications and may increase [[drug-related side effects and adverse reactions]]s<ref name="pmid11251757">{{cite journal |author=Muir AJ, Sanders LL, Wilkinson WE, Schmader K |title=Reducing medication regimen complexity: a controlled trial |journal=J Gen Intern Med |volume=16 |issue=2 |pages=77–82 |year=2001 |pmid=11251757 |doi=10.1046/j.1525-1497.2001.016002077.x |issn=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pubmedid=11251757 Full text at PubMed Central]</ref>. | ||
Taking 4 or more prescriptions daily is more common among low income patients according to one survey.<ref> USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey: the public on prescription drugs and pharmaceutical companies - kaiser family foundation. Retrieved March 10, 2008, from http://www.kff.org/kaiserpolls/pomr030408pkg.cfm.</ref> This occurs in 32% of patients with household income below $25,000; whereas this occurs in 12% of those with household income above $75,000. | Taking 4 or more prescriptions daily is more common among low income patients according to one survey.<ref> USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey: the public on prescription drugs and pharmaceutical companies - kaiser family foundation. Retrieved March 10, 2008, from http://www.kff.org/kaiserpolls/pomr030408pkg.cfm.</ref> This occurs in 32% of patients with household income below $25,000; whereas this occurs in 12% of those with household income above $75,000. | ||
Using 11 or more chronic [[medication]]s is a risk factor for [[drug toxicity]].<ref name="pmid21693525">{{cite journal| author=Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K| title=High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. | journal=BMJ | year= 2011 | volume= 342 | issue= | pages= d3514 | pmid=21693525 | doi=10.1136/bmj.d3514 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21693525 }} </ref> | |||
Combining multiple medications into a single 'polypill' may help patients.<ref>{{Cite journal | |||
| doi = 10.1016/S0140-6736(09)60611-5 | |||
| issn = 0140-6736 | |||
| volume = In Press, Corrected Proof | |||
| title = Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial | |||
| journal = The Lancet | |||
| accessdate = 2009-03-31 | |||
| url = http://www.sciencedirect.com/science/article/B6T1B-4VYKJR5-2/2/24145faff36b7d9e92ff1687d96d02e5 | |||
}}</ref> | |||
However, taking "three drugs at half standard dose in combination" may be better than one drug at standard dose according to a [[systematic review]].<ref name="pmid19454737">{{cite journal |author=Law MR, Morris JK, Wald NJ |title=Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies |journal=BMJ |volume=338 |issue= |pages=b1665 |year=2009 |pmid=19454737 |pmc=2684577 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=19454737 |issn=}}</ref> | |||
==Reducing polypharmacy== | |||
Matching patients' medical problems and their medicines may identify unneeded or low priority drugs that can be discontinued.<ref name="pmid20940385">{{cite journal| author=Steinman MA, Hanlon JT| title=Managing medications in clinically complex elders: "There's got to be a happy medium". | journal=JAMA | year= 2010 | volume= 304 | issue= 14 | pages= 1592-601 | pmid=20940385 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20940385 | doi=10.1001/jama.2010.1482 }} </ref> | |||
Delaying antibiotics for 48 hours while waiting on improvement of [[respiratory tract infection]]s<ref name="pmid17636757">{{cite journal |author=Spurling G, Del Mar C, Dooley L, Foxlee R |title=Delayed antibiotics for respiratory infections |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004417 |year=2007 |pmid=17636757 |doi=10.1002/14651858.CD004417.pub3}}</ref><ref name="pmid19843421">{{cite journal| author=Moore M, Little P, Rumsby K, Kelly J, Watson L, Warner G et al.| title=Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection. | journal=Br J Gen Pract | year= 2009 | volume= 59 | issue= 567 | pages= 728-34 | pmid=19843421 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19843421 | doi=10.3399/bjgp09X472601 | pmc=PMC2751917 }} </ref> or [[cystitis]]<ref name="pmid19364448">{{cite journal |author=Little P, Turner S, Rumsby K, ''et al'' |title=Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study |journal=Health Technol Assess |volume=13 |issue=19 |pages=iii–iv, ix–xi, 1–73 |year=2009 |month=March |pmid=19364448 |doi=10.3310/hta13190 |url=http://www.hta.ac.uk/execsumm/summ1319.htm |issn=}}</ref> may reduce antibiotic usage and reconsultation; however, this strategy may reduce patient satisfaction. | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Latest revision as of 17:35, 10 February 2024
Polypharmacy is defined as "the use of multiple drugs administered to the same patient, most commonly seen in elderly patients. It includes also the administration of excessive medication."[1] Polypharmacy hinders patient compliance with medications and may increase drug-related side effects and adverse reactionss[2].
Taking 4 or more prescriptions daily is more common among low income patients according to one survey.[3] This occurs in 32% of patients with household income below $25,000; whereas this occurs in 12% of those with household income above $75,000.
Using 11 or more chronic medications is a risk factor for drug toxicity.[4]
Combining multiple medications into a single 'polypill' may help patients.[5]
However, taking "three drugs at half standard dose in combination" may be better than one drug at standard dose according to a systematic review.[6]
Reducing polypharmacy
Matching patients' medical problems and their medicines may identify unneeded or low priority drugs that can be discontinued.[7]
Delaying antibiotics for 48 hours while waiting on improvement of respiratory tract infections[8][9] or cystitis[10] may reduce antibiotic usage and reconsultation; however, this strategy may reduce patient satisfaction.
References
- ↑ National Library of Medicine. Polypharmacy. Retrieved on 2007-12-15.
- ↑ Muir AJ, Sanders LL, Wilkinson WE, Schmader K (2001). "Reducing medication regimen complexity: a controlled trial". J Gen Intern Med 16 (2): 77–82. DOI:10.1046/j.1525-1497.2001.016002077.x. PMID 11251757. Research Blogging. Full text at PubMed Central
- ↑ USA Today/Kaiser Family Foundation/Harvard School of Public Health Survey: the public on prescription drugs and pharmaceutical companies - kaiser family foundation. Retrieved March 10, 2008, from http://www.kff.org/kaiserpolls/pomr030408pkg.cfm.
- ↑ Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K (2011). "High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice.". BMJ 342: d3514. DOI:10.1136/bmj.d3514. PMID 21693525. Research Blogging.
- ↑ "Effects of a polypill (Polycap) on risk factors in middle-aged individuals without cardiovascular disease (TIPS): a phase II, double-blind, randomised trial". The Lancet In Press, Corrected Proof. DOI:10.1016/S0140-6736(09)60611-5. ISSN 0140-6736. Retrieved on 2009-03-31. Research Blogging.
- ↑ Law MR, Morris JK, Wald NJ (2009). "Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies". BMJ 338: b1665. PMID 19454737. PMC 2684577. [e]
- ↑ Steinman MA, Hanlon JT (2010). "Managing medications in clinically complex elders: "There's got to be a happy medium".". JAMA 304 (14): 1592-601. DOI:10.1001/jama.2010.1482. PMID 20940385. Research Blogging.
- ↑ Spurling G, Del Mar C, Dooley L, Foxlee R (2007). "Delayed antibiotics for respiratory infections". Cochrane database of systematic reviews (Online) (3): CD004417. DOI:10.1002/14651858.CD004417.pub3. PMID 17636757. Research Blogging.
- ↑ Moore M, Little P, Rumsby K, Kelly J, Watson L, Warner G et al. (2009). "Effect of antibiotic prescribing strategies and an information leaflet on longer-term reconsultation for acute lower respiratory tract infection.". Br J Gen Pract 59 (567): 728-34. DOI:10.3399/bjgp09X472601. PMID 19843421. PMC PMC2751917. Research Blogging.
- ↑ Little P, Turner S, Rumsby K, et al (March 2009). "Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study". Health Technol Assess 13 (19): iii–iv, ix–xi, 1–73. DOI:10.3310/hta13190. PMID 19364448. Research Blogging.