Microsoft word - handouts.by.section.polypharmacy.doc
(1) Polypharmacy has multiple definitions: the concurrent use of multiple medications, prescribing more medication than clinically indicated, a medical regimen that includes at least 1 unnecessary medication or the use of 5 or more medications.1
A 2003 survey of over 17,000 Medicare recipients >65 years old showed:2
o 46% of seniors take 5 or more medications daily o 73% of seniors with chronic illnesses take 5+ meds daily
chronic conditions multiple symptoms multiple providers multiple pharmacies drugs administered by multiple routes
The prescribing cascade: when a drug-related symptoms and side effects lead to the prescribing of more medications.1 When an older patient presents with new signs/symptoms remember to list polypharmacy on the differential!
(2) What are the complications of polypharmacy? 3,4 •
(3) Medications associated with adverse drug events Polypharmacy may be necessary for the optimal management of chronic disease (e.g. heart failure, diabetes) but certain classes of medications are often associated with adverse events and others are rarely indicated in the elderly •
Risk of ADE highest for steroids, anticoagulants, antibiotics, analgesics and CV medications7 (Forster et al)
The Beers criteria – a list of drugs that are potentially inappropriate in the elderly developed by a consensus panel of geriatricians and pharmacologists1
Consider each patient individual y. If the drug is necessary and the patient has tolerated it without adverse effect may continue it
Commonly seen medications in the inpatient setting: antihistamines (benadryl, atarax), diphenoxylate (Lomotil), oxybutynin (Ditropan), ketorolac (Toradol)
(4) Interventions to decrease polypharmacy & prevent medication errors1,3,4
get al medications from a single pharmacy
keep an updated list of medications (incl OTC, topicals, inhaled meds)
inform PMD if another provider changes medications
use each patient encounter as an opportunity to stream-line the medication list
ask about adherence at each encounter and especially at care transitions
know which medications are “inappropriate” for elderly patient
when making medication changes, clearly explain the name, indication, and instructions for taking new meds. Discuss adverse reactions and what to do if they occur. Ask the patient/caregiver to repeat information back to you.
JCAHO has mandated medication reconciliation!8
(5) Non-adherence is common and increases with polypharmacy2 66% of seniors with chronic illnesses who lacked insurance coverage
25% of pts did not fill at least 1 or more prescriptions due to cost 20% spent less on basic needs in order to afford medications 20% skipped doses or stopped a medicine because of side effects 20% stopped medicines they believed were not helping *Age itself is not predictive of non-adherence9*
1 Williams, Cynthia. Using medications appropriately in older adults. Am Fam Physician 2002;66:1917-24. 2 Safran et al. Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey. Health Affairs April 19, 2005. http://content.healthaffairs.org/ cgi/content/abstract/hlthaff.w5.152v1 Accessed online on July 24, 2006. 3 Colley and Lucus. Polypharmacy: The cure becomes the disease. J Gen Intern Med 1993;8:278-283. 4 Drake and Romano. How to protect your older patient from the hazards of polypharmacy. Nursing June 1995:34-39. 5 Harris, Gardiner. Report finds a heavy toll from medication errors. The NY Times July 21, 2006. 6 Preventing Medication Errors: Quality Chasm Series. http://www.nap.eud/ catalog/11623.html Accessed online July 24, 2006. 7 Forster et al. Adverse Drug Events Occurring following Hospital Discharge J Gen Intern Med 2005; 20:317-323. 8 FAQs for the 2006 National Patient Safety Goals. Accessed online July 24, 2006. http://www.jointcommission.org/NR/rdonlyres/7C116D6D-AE82-449E-BA45-1DE49D2A0A34/0/06_npsg_faq.pdf 9 Vik et al. Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 2004;38:303-12.
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Comprehensive Guide to Interpersonal explaining IPT concepts and issues to pa-cludes with a look at “The Future of IPT” Psychotherapy tients. As an IPT supervisor, I find thatclinicians new to IPT thirst for practical,how- to ways to conduct the therapy. Sug-gested scripts were available in the 1984 Comprehensive Guide more than an up-riches this section as a training manual.
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