medicine: polypharmacy and multiple condition patients

October 25, 2011
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The Growing Challenge of Multi-Condition Patients

Staying current on drug information is key in managing comorbidities and associated polypharmacy

Our aging population is subject to multiple conditions in increasing numbers. Roughly one in four adults has two or more chronic conditions; half of older adults have three or more (Boyd, et al, Public Health Rev, 2010;32(2):451-474). While established therapies to treat one condition may be well understood, multiple simultaneous conditions—and treatments—interact to present new levels of complexity for healthcare professionals. For example, it is often not clear how to apply existing guidelines to multiple comorbidities. Different prescriptions are sometimes filled at different pharmacies, increasing the chance of dispensing a drug that interacts with or is contraindicated with another.

Poor adherence common in polypharmacy can also contribute to greater risk of medication errors. In the 2007 Guideline Study of Physician Opinions on Non-Compliance, 47% of participants’ patients were on four or more medications; 51% were non-compliant behaviorally and attitudinally.

Paradoxically, polypharmacy can also result in undertreatment; in a study of older patients, the probability of receiving an indicated drug dropped significantly as the number of drugs prescribed increased.

And the incidence of adverse drug reactions also increases with the number of drugs prescribed, even when all of the various treatment guidelines are followed.

Solving the Problem
One interesting approach in the elderly is to develop tools such as the Drug Burden Index, (Hilmer, et al, Arch Int Med. 2007;167(8):781-787), which measures a patient’s total exposure to anticholinergic and sedative medications using the principles of dose-response—a better indication of the risks of polypharmacy than simply counting drugs.

These data illustrate the importance of ongoing communication among prescribers, pharmacists, patients, and caregivers. They also speak to embracing medication audits and adherence programs as part of basic patient care. PDR Network has always provided full prescribing information and will increasingly provide resources to support your goals for patient outcomes and safe medication use.
For full prescribing information, visit www.pdr.net. We welcome your comments or questions at mdfeedback@pdr.net.

Steven Merahn, MD
Chief Medical Officer
PDR Network

3 Responses to medicine: polypharmacy and multiple condition patients

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