When a patient is regularly taking multiple medications, extra care is required to ensure their efficacy. It’s a complex situation faced by doctors and other care providers, including pharmacists. The term for this increasingly common situation is known as polypharmacy.
Polypharmacy involves a patient regularly taking more than 4 prescription medications simultaneously. This issue is unfortunately commonplace among elderly patients, where avoiding adverse reactions due to drug interactions becomes paramount.
Let’s analyze the issue of polypharmacy in more detail. We also provide insights on how community pharmacies are able to manage this condition when possible.
Defining Polypharmacy
As noted earlier, polypharmacy is when a patient is taking a multitude of medications on a regular basis. Most experts define the low end of that multitude as either four or five. Studies reveal 40 percent of patients over 65 take more than 5 medications; 20 percent take more than 10.
Polypharmacy is a condition that needs monitored by a medical professional, including community pharmacists.
Patients suffering from multiple medical conditions tend to be the ones with polypharmacy. However, both over-the-counter medications and even supplements do contribute to this situation. While polypharmacy occurs more often with older patients, it still needs to be analyzed in certain at-risk younger individuals.
Polypharmacy must be monitored by a Medical Professional
Polypharmacy by itself isn’t automatically “good” or “bad.” The situation must be managed by a medical professional: a PCP, pharmacist, or both. When handled in a safe and healthy fashion, it is known as “appropriate polypharmacy.”
Here are some of the attributes a medical professional looks for when determining appropriate pharmacy:
· A patient taking the lowest amount of prescribed medications possible
· Only prescribing the right medications for the patient’s medical needs
· A patient regularly takes all prescribed medications with no issues
· A patient has no unmanageable side effects
· A patient has no harmful reactions to medications
· A patient has no harmful interactions between medications and their current health conditions
· A patient regularly reviews current medications with their PCP, pharmacist, or both
· A patient must check with their healthcare provider before taking any new supplements
· A patient must work with their healthcare provider to change or stop medications when necessary
The Risks of Inappropriate Polypharmacy
Unmanaged polypharmacy raises the risk level for any patient, but it becomes especially critical for older persons. Not surprisingly, the risk of adverse drug interactions naturally increases as more medications are taken.
Additionally, aging patients need to worry about polypharmacy causing dementia, delirium, and an increased risk of frailty and falls. Overmedication also needs to be considered. This issue might lead to severe side effects in any patient.
Understanding the Causes of Polypharmacy
One obvious cause of polypharmacy involves patients suffering from many chronic conditions simultaneously. Without awareness or management from a health professional, it might lead to a feedback loop resulting in additional health problems.
Another contributing factor to polypharmacy is poor or non-existent communication between health providers. This situation becomes especially problematic with medical specialists. Pharmacists need to be proactive in fostering seamless communication to prevent this issue.
Also, patients without a regular PCP, especially those in medical deserts, are at an increased risk of polypharmacy. The pharmacist needs to ask about a patient’s current medications (OTC and prescription) and supplements when filling their prescriptions. Perhaps a deprescribing approach is necessary? Analyzing this and any potential social determinants of health (SDoH) issues becomes paramount in this scenario.
In the end, polypharmacy isn’t necessarily bad when it’s properly managed. However, inappropriate polypharmacy greatly increases the medical risks for patients, especially older ones. A trusted community pharmacist ultimately plays a critical role in managing polypharmacy while ensuring patient health.
