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Polypharmacy: misleading, but manageable.

Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN - Clin Interv Aging (2008)

Bottom Line: Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing.Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication.The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Services, Medical University of South Carolina, Charleston, South Carolina, USA. busharrl@musc.edu

ABSTRACT
The percentage of the population described as elderly is growing, and a higher prevalence of multiple, chronic disease states must be managed concurrently. Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing. The purpose of this study is to identify a consensus definition for polypharmacy and evaluate its prevalence among elderly outpatients. The authors also sought to identify or develop a clinical tool which would assist healthcare practitioners guard against inappropriate drug therapy in elderly patients. The most commonly cited definition was a medication not matching a diagnosis. Inappropriate was part of definitions used frequently. Some definitions placed a numeric value on concurrent medications. Two common definitions (ie, 6 or more medications or a potentially inappropriate medication) were used to evaluate polypharmacy in elderly South Carolinians (n = 1027). Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication. The findings are 29.4% are prescribed 6 or more concurrent drugs, 15.7% are prescribed one or more potentially inappropriate drugs, and 9.3% meet both definitions of polypharmacy used in this study. The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use. A structured approach to identify and manage inappropriate polypharmacy is suggested and a clinical tool is provided.

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Related in: MedlinePlus

Hyperpharmacotherapy assessment tool (Adapted with permission from Bergman-Evans B. 2006 Evidence-based guideline: Improving medication management for older adult clients. J Gerontol Nurs, 32:6–14).
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fig1: Hyperpharmacotherapy assessment tool (Adapted with permission from Bergman-Evans B. 2006 Evidence-based guideline: Improving medication management for older adult clients. J Gerontol Nurs, 32:6–14).

Mentions: Feinberg and Simonson (2005) suggest a comprehensive review of a patient’s drug regimen be performed annually, or more frequently if indicated. Several clinical tools have been published to help providers reduce hyperpharmacotherapy. Bushardt and Jones (2005) previously developed and published a series of nine questions for physician assistants to use to guide the drug therapy evaluation process (see Table 3). We have developed a comprehensive tool called the Hyperpharmacotherapy Assessment Tool (HAT), adapted from Bergman-Evans’ Medication Management Outcome Monitor (2006). It appears in Figure 1. Modifications were made to create a more concise tool as well as to include pertinent components not listed in the form developed by Bergman-Evans. Additional research by physician assistants can further refine this instrument.


Polypharmacy: misleading, but manageable.

Bushardt RL, Massey EB, Simpson TW, Ariail JC, Simpson KN - Clin Interv Aging (2008)

Hyperpharmacotherapy assessment tool (Adapted with permission from Bergman-Evans B. 2006 Evidence-based guideline: Improving medication management for older adult clients. J Gerontol Nurs, 32:6–14).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2546482&req=5

fig1: Hyperpharmacotherapy assessment tool (Adapted with permission from Bergman-Evans B. 2006 Evidence-based guideline: Improving medication management for older adult clients. J Gerontol Nurs, 32:6–14).
Mentions: Feinberg and Simonson (2005) suggest a comprehensive review of a patient’s drug regimen be performed annually, or more frequently if indicated. Several clinical tools have been published to help providers reduce hyperpharmacotherapy. Bushardt and Jones (2005) previously developed and published a series of nine questions for physician assistants to use to guide the drug therapy evaluation process (see Table 3). We have developed a comprehensive tool called the Hyperpharmacotherapy Assessment Tool (HAT), adapted from Bergman-Evans’ Medication Management Outcome Monitor (2006). It appears in Figure 1. Modifications were made to create a more concise tool as well as to include pertinent components not listed in the form developed by Bergman-Evans. Additional research by physician assistants can further refine this instrument.

Bottom Line: Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing.Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication.The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Services, Medical University of South Carolina, Charleston, South Carolina, USA. busharrl@musc.edu

ABSTRACT
The percentage of the population described as elderly is growing, and a higher prevalence of multiple, chronic disease states must be managed concurrently. Healthcare practitioners must appropriately use medication for multiple diseases and avoid risks often associated with multiple medication use such as adverse effects, drug/drug interactions, drug/disease interactions, and inappropriate dosing. The purpose of this study is to identify a consensus definition for polypharmacy and evaluate its prevalence among elderly outpatients. The authors also sought to identify or develop a clinical tool which would assist healthcare practitioners guard against inappropriate drug therapy in elderly patients. The most commonly cited definition was a medication not matching a diagnosis. Inappropriate was part of definitions used frequently. Some definitions placed a numeric value on concurrent medications. Two common definitions (ie, 6 or more medications or a potentially inappropriate medication) were used to evaluate polypharmacy in elderly South Carolinians (n = 1027). Data analysis demonstrates that a significant percentage of this population is prescribed six or more concomitant drugs and/or uses a potentially inappropriate medication. The findings are 29.4% are prescribed 6 or more concurrent drugs, 15.7% are prescribed one or more potentially inappropriate drugs, and 9.3% meet both definitions of polypharmacy used in this study. The authors recommend use of less ambiguous terminology such as hyperpharmacotherapy or multiple medication use. A structured approach to identify and manage inappropriate polypharmacy is suggested and a clinical tool is provided.

Show MeSH
Related in: MedlinePlus