Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems

Diakonhjemmet Hospital Pharmacy, Faculty of Medicine, University of Oslo, Oslo, Norway.
British Journal of Clinical Pharmacology (Impact Factor: 3.88). 03/2007; 63(2):187-95. DOI: 10.1111/j.1365-2125.2006.02744.x
Source: PubMed


To investigate whether polypharmacy defined as a definite number of drugs is a suitable indicator for describing the risk of occurrence of drug-related problems (DRPs) in a hospital setting.
Patients admitted to six internal medicine and two rheumatology departments in five hospitals were consecutively included and followed during the hospital stay, with particular attention to medication and DRPs. Comparisons were made between patients admitted with five or more drugs and with less than five drugs. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions.
Of a total of 827 patients, 391 (47%) used five or more drugs on admission. Patients admitted with five or more and less than five drugs were prescribed the same number of drugs after admission: 4.1 vs. 3.9 drugs [P = 0.4, 95% confidence interval (CI) - 0.57, 0.23], respectively. The proportion of drugs used on admission which was associated with DRPs was similar in the patient group admitted with five or more drugs and in those admitted with less than five drugs. The number of DRPs per patient increased approximately linearly with the increase in number of drugs used; one unit increase in number of drugs yielded a 8.6% increase in the number of DRPs (95% CI 1.07, 1.10).
The number of DRPs per patient was linearly related to the number of drugs used on admission. To set a strict cut-off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value when assessing DRPs in a clinical setting.

Download full-text


Available from: Kirsten K Viktil
  • Source
    • "It is now recommended to use less ambiguous terminology such as hyperpharmacotherapy or multiple medication use. The presence of drug related problems (DRPs) has been shown to increase approximately linearly with the number of drugs used, for the range of one to more than 11 drugs [8]. Ciprofloxacin, a second generation fluoroquinolone antibiotic (FA), is commonly used to treat a respiratory exacerbation in CF patients. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cystic fibrosis (CF) is a common autosomal recessive disorder in Caucasian populations with respiratory, gastrointestinal and endocrine manifestations. Thanks to recent advances in medical therapies and infection control, life expectancy of a patient with CF has significantly increased from less than 5 years in the mid-1900s to almost 50 years nowadays. However, as CF patients are living longer, multimorbidity and Hyperpharmacotherapy are becoming more common. This case illustrates a cascade of problems that ensued from medication side-effects, highlighting the increasing challenge of managing an ageing CF population.
    Full-text · Article · Oct 2015 · Respiratory Medicine Case Reports
  • Source
    • "Inappropriate drug use has been largely studied in the elderly, a population characterized by frailty, polymorbidity and polymedication; fewer studies have addressed the question in internal medicine wards, in which younger patients are admitted. It has been shown that polymorbidity and polymedication were independent risk factors of DRPs, whereas age and gender were not [13] [14]. Elderly and "
    [Show abstract] [Hide abstract]
    ABSTRACT: Patients admitted to general internal medicine wards might receive a large number of drugs and be at risk for drug-related problems (DRPs) associated with increased morbidity and mortality. This study aimed to detect suboptimal drug use in internal medicine by a pharmacotherapy evaluation, to suggest treatment optimizations and to assess the acceptance and satisfaction of the prescribers. This was a 6-month prospective study conducted in two internal medicine wards. Physician rounds were attended by a pharmacist and a pharmacologist. An assessment grid was used to detect the DRPs in electronic prescriptions 24h in advance. One of the following interventions was selected, depending on the relevance and complexity of the DRPs: no intervention, verbal advice of treatment optimization, or written consultation. The acceptance rate and satisfaction of prescribers were measured. In total, 145 patients were included, and 383 DRPs were identified (mean: 2.6 DRPs per patient). The most frequent DRPs were drug interactions (21%), untreated indications (18%), overdosages (16%) and drugs used without a valid indication (10%). The drugs or drug classes most frequently involved were tramadol, antidepressants, acenocoumarol, calcium-vitamin D, statins, aspirin, proton pump inhibitors and paracetamol. The following interventions were selected: no intervention (51%), verbal advice of treatment optimization (42%), and written consultation (7%). The acceptance rate of prescribers was 84% and their satisfaction was high. Pharmacotherapy expertise during medical rounds was useful and well accepted by prescribers. Because of the modest allocation of pharmacists and pharmacologists in Swiss hospitals, complementary strategies would be required. Copyright © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
    Full-text · Article · Jun 2015 · European Journal of Internal Medicine
  • Source
    • "Causes of readmissions are multi-factorial and many interventions targeted at high-risk patients have been attempted hitherto, albeit with varying degree success (Hansen et al., 2011). Increased age, multiple comorbidities and polypharmacy, widely defined as the use of five or more drugs, have been identified as contributory factors with the highest risk of readmission Kansagara et al. (2011), Viktil et al. (2007). While age and the presence of comorbidities are unmodifiable, polypharmacy may be addressed via a variety of ways such as medication reconciliation and adoption of judicious prescribing strategies Hanlon et al. (1996). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To investigate whether number of doses per day and number of medications are significantly associated with the number of readmissions and to study the association of readmission frequency with other medical and socio-demographic variables. Methods: Retrospective cross-sectional study involving 432 patients who were readmitted within 15. days of previous hospital discharge between January 1, 2013 and March 31, 2013. Relevant medical records were collected from the national electronic databases of every public tertiary hospital in Singapore. Significant variables (. p<. 0.05) were identified using forward selection and modeled using generalized linear mixed models. Results: A total of 649 unplanned readmissions were reviewed. At a multivariable level, number of readmission was significantly associated with the number of medications (. p=. 0.002) and number of doses per day (. p=. 0.003) after adjusting for race, liver disease, schizophrenia and non-compliance. Conclusion: Complex medication regimen (i.e. multiple medications and multiple doses per day) is a statistically significant predictor of number of readmissions. Simplifying therapeutic regimens with alternatives such as longer-acting or fixed-dose combination drugs may facilitate better patient adherence and reduce costly readmissions.
    Full-text · Article · Dec 2014
Show more